Jensen T Poon, MBBS MS, Chi-wai Cheung, MBBS, Wai-lun Law, MBBS MS, Joe K Fan, MBBS MS, Siu-hung Lo, MBBS, Miu Y Chan, MBBS. Department of Surgery & Department of Anesthesia, The University of Hong Kong, Queen Mary Hospital, Hong Kong
Introduction:This randomized controlled study compared the operative outcome of single port laparoscopic colectomy (SPLC) and conventional laparoscopic colectomy (CLC). The primary outcome measure was the post-operative pain.
Methods: Patients who had small cancer (<4cm) or adenomatous polyp requiring colectomy were randomized to have SPLC or CLC. All patients had patient controlled analgesia after operation and their visual analogue score of pain (pain score) on day 1-3 and14 were recorded by research staff. Both the patients and research staff were blinded to the type of procedure. Other operative outcomes and the characteristics of the two groups of patients were also recorded prospectively and compared. Categorical variables were compared by Chi-square test or Fisher’s exact test as appropriate. Continuous variables were presented as their median (interquartile range) and were compared by Mann-Whitney U test. P value of <0.05 was regarded as statistically significant.
Results: The SPLC group had 23 patients (8 right colectomy, 3 left colectomy, 12 anterior resection) and complication occurred in one patient who had wound infection. The CLC groups had also 23 patients (9 right colectomy, 3 left colectomy, 12 anterior resection) and complication occurred in three patients (wound infection x2 & ileus x1). There was no operative mortality in both groups. The comparison of patient characteristics and operative outcomes was presented in Table 1. The patient demographics, operating time, blood loss were similar between the 2 groups. When compared to the CLC group, the SPLC group had significantly lower pain score at rest on day 1 [3 (1-5) vs. 0 (0-2); p <0.01], day 2 [2 (0-4) vs. 0 (0-2); p=0.02] after operation and shorter hospital stay [5 (4-6) vs. 4 (3-4) days; p<0.01]. There was no difference in the margins of resection.
Conclusions: Single port laparoscopic colectomy is a safe procedure with low complication rate. Compared with conventional laparoscopic colectomy, single port procedure is associated with reduced wound pain in early post-operative period and shorter hospital stay.
|
SPLC (n=23) |
CLC(n=23) |
P value |
|
|
Age |
69 (60-78) |
67 (57-74) |
0.48 |
|
Body mass index |
22.6 (19.4-25.5) |
23.6 (20.5-26.2) |
0.59 |
|
Male |
52.2% | 69.6% |
0.23 |
|
ASA class 1 – 2 – 3 |
3 – 17 – 3 |
3 – 16 – 3 |
0.92 |
|
Previous operation |
26% |
34.7% |
0.52 |
|
Operating time (minutes) |
152 (111-175) |
124 (124-170) |
0.32 |
|
Blood loss (ml) |
62.3 (30-90) |
80 (45-97.5) |
0.28 |
|
Hospital stay (days) |
4 (3-4) |
5 (4-6) |
<0.01 |
|
Malignant lesion |
19 |
19 |
1 |
|
Complication rate |
4.3% |
13% |
0.35 |
|
Tumor size (cm) |
3 (2.5-4) |
4 (3-4) |
0.38 |
|
Proximal margin (cm) |
8 (6-23.5) |
9 (6-10.5) |
0.80 |
|
Distal margin (cm) |
5.5 (5-8.5) |
6 (5-9) |
0.84 |
|
Morphine usage (mg) |
11 (5-24) | 19 (8-41) | 0.12 |
|
Pain score at rest |
|||
|
Day 1 |
0 (0-2) |
3 (1-5) |
<0.01 |
|
Day 2 |
0 (0-2) |
2 (0-4) |
0.02 |
|
Day 3 |
0 (0-2) |
2 (0-3) |
0.14 |
|
Day 14 |
0 (0-1) |
0 (0-1) |
0.93 |
|
Pain score at cough |
|||
|
Day 1 |
5 (3-6) |
5 (4-8) |
0.06 |
|
Day 2 |
4 (2-5) |
5 (3-7) |
0.05 |
|
Day 3 |
3 (1-5) |
4 (2-5) |
0.12 |
|
Day 14 |
0 (0-3) |
1 (0-3) |
0.34 |
Session Number: SS16 – SILS
Program Number: S090