Low early postoperative wound complication rate after single-incision laparoscopic colectomy using straight laparoscopic instruments

Nathan Hansen, MD, Huy Nguyen, DO, Sherry Wren, MD, Dan Eisenberg, MD. Stanford School of Medicine and Palo Alto VA HCS.

Background: Laparoscopic colectomy represents a minority of colon resections performed. Single-incision laparoscopic colectomy requires specific expertise and carries a potential concern for wound complication. Here we study early postoperative wound complication rates.

Methods: A prospective database of consecutive single-incision laparoscopic colectomies performed by two surgeons at a single institution was retrospectively reviewed. Straight laparoscopic instruments and a 5-mm, 30-degree laparoscope were introduced through a SILS™ port (Covidien, New Haven, CT) after a 3 cm fascial incision and a 2.5 cm skin incision were made. Specimens were removed through the single incision using an Alexis® wound protector (Applied Medical, Rancho Santa Margarita, CA). The fascia was closed with interrupted figure-eight 0-vicryl suture. Patients were discharged from hospital after tolerating oral diet and resumption of bowel function, and seen in follow-up 2 weeks after surgery.

Results: Thirteen patients underwent single-incision laparoscopic colectomy by a single surgeon. Four patients underwent left colectomy, six right colectomy, two low anterior resection, and one abdominoperineal resection; six of the operations were performed for cancer. They had a mean age of 66 years, 54% were male, and mean body mass index was 23.8 kg/m2. Average length of stay was 5.5 days. Wound infection, seroma, and fascial dehiscence were identified in 0/13 patients.

Conclusion: Single incision laparoscopic colectomy using straight instruments and a 3-cm fascial umbilical incision can be performed with minimal postoperative wound complications.

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