Single Port Access (spa) Colon Resection: a Comparison to Multiport Laparoscopic (mpl) Colectomy

The Single Port Access (SPA) technique was developed as an alternative to standard multiport laparoscopic (MPL) procedures. The initial advantage SPA surgery offers is the ability to perform standard laparoscopic dissection techniques through a single incision, thus offering improved cosmesis. It is important to compare this novel technique to the proven MPL technique in terms of outcomes and safety. We compare our initial experience with SPA colon resection to MPL colon resection.

Ten colectomies were performed using the SPA access technique. Through a 2.0 cm initial incision, a clear 5mm trocar is centrally placed and two low profile 5mm trocars are then placed laterally by raising skin and soft tissue flaps. A fourth small fascial defect is made inferiorly to accommodate a rigid grasping instrument for retraction. These ten SPA colectomies were reviewed in a retrospective fashion compared to ten standard MPL colon resections using three to four separate port sites. In both groups, all anastomoses were performed extracorporeally by extending the primary incision and delivering the colon. All procedures were performed by a single surgeon (PGC).

Both groups included right colon and sigmoid colon resections, as well as total proctocolectomy with J-Pouch. The MPL group included one left colon resection and the SPA group included one transverse colon resection. Diagnosis included colon mass (benign and malignant), ulcerative colitis, and sigmoid diverticulitis.

Operative time was 30% longer in the SPA group, but times decreased with experience. EBL and LOS were comparable for both groups. Each group had one wound infection at the primary incision site. Nodes retrieved were comparable (12-21) in both groups in those patients with cancer. Each group has had one hernia at the primary incision site. Incision length at the primary site was comparable in both groups.

SPA colectomy is an acceptable alternative to standard multiport colectomy. Outcomes and operative technique are similar to MPL colon resection while offering the benefit of elimination of incisions beyond the primary site of entry. Further studies will have to be performed to determine benefits such as decreased pain and improved recovery.

Session: Podium Presentation

Program Number: S130

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