Andrea L Jester, MD, Michael J Guzman, MD, Joshua A Waters, MD, Bruce Robb, MD, Don L Selzer, MD, Virgilio V George, MD. Department of Surgery, Indiana University School of Medicine
INTRODUCTION: The safety and efficacy of standard laparoscopic colectomy in both benign and malignant diseases has been well-established. Single port laparoscopic surgery is emerging as a technique that may minimize morbidity and improve cosmetic results. It remains to be seen if single port laparoscopic colectomy can be performed safely at high-risk, tertiary care centers. This retrospective review compares single port laparoscopic right colectomy (SPLRC) to standard laparoscopic right colectomy in benign and malignant diseases in the immediate post-operative period at a single Veterans Affairs hospital.
METHODS: A retrospective collection of data was performed for patients who underwent a single port laparoscopic or standard laparoscopic right colectomy for benign or malignant disease at the Roudebush VA Hospital in Indianapolis, IN between July 2007 and September 2010. Data regarding patient demographics, disease process, intraoperative parameters and short-term post-operative outcomes were analyzed.
RESULTS: Between July 2007 and September 2010, 74 patients underwent a standard laparoscopic right colectomy, and 27 patients underwent a SPRLC. There was no statistically significant difference between the two groups when compared by age, gender, ASA, BMI or diagnosis. There were no conversions to standard laparoscopy or laparotomy in the SPLRC group, and there were no conversions to laparotomy in the laparoscopic group. The mean operative time for SPLRC group was 105 ± 28 minutes, which was similar to the mean operative time for the standard laparoscopic approach (114 ± 63 minutes); furthermore, there was no statistically significant difference in the mean estimated blood loss documented when the SPLRC group was compared to the standard laparoscopic group (50 ml vs. 68 ml, respectively). There was no statistically significant difference in the mean length of hospital stay between the SPLRC group and the standard laparoscopic group (5.64 ± 5.6 days vs. 4.90 ± 3.7 days, respectively) or in the amount of time until return of bowel function (3.43 ± 2.22 days vs. 3.49 ± 2.29 days, respectively). For the subset of patients with malignant disease, there was no statistically significant difference in the mean specimen length (24.6 cm vs. 25.4 cm), mean number of lymph nodes harvested in the specimen (19 vs. 18) or specimens with a positive radial margin (1 vs. 2) in the SPLRC group when compared to the standard laparoscopic group. There were no intra-operative complications in either group. No statistically significant difference in the two groups in regards to post-operative complications (13.6 vs. 14.6 %) or mortality (0 vs. 4.8 %) was observed.
CONCLUSIONS: These results suggest that single port laparoscopic right colectomy for benign and malignant disease can be performed in a safe manner in the high-risk patient population found at a VA hospital. Furthermore, this less invasive approach has similar morbidity and mortality to standard laparoscopy but confers a better cosmetic result with perhaps less tissue trauma. This preliminary data suggests that larger, randomized studies should be performed to determine whether or not SPLRC is equivalent to standard laparoscopic approach with regard to long term complications and is cost effective in this high-risk population.
Program Number: S118