Single Incision Laparoscopic Colectomy for Colon Cancer: Technical Aspects and Feasibility

Toshimasa Yatsuoka, MD, Yasuyuki Yokoyama, MD, Yoji Nishimura, MD, Hirohiko Sakamoto, MD, Yoichi Tanaka, MD. Saitama Cancer Center

INTRODUCTION: In the attempt to reduce even more the cutaneous and parietal trauma, single incision laparoscopic surgery (SILS) has been proposed in the field of minimally invasive colon surgery. We present a series of six cases of single incision laparoscopic right hemicolectomy for colon cancer. The aim of our report was to analyze the safety, techniques and feasibility of this new surgical technique for patients with colon cancer.

METHODS AND PROCEDURES: Between December 2009 and October 2010, six selected patients whose informed consent was obtained underwent single incision laparoscopic colectomy (SILC). This series consisted of six right sided colon cancers. A longitudinal periumbilical incision was used for all cases using two different access techniques. The one was glove port technique and the other was technique to place three ports through the linea alba (glove technique in four cases and direct access in two cases) with standard laparoscopic instruments. Demographic data, intraoperative parameters, and postoperative outcomes were assessed. Inclusion criteria were no intra-abdominal sepsis, no distant metastases and a BMI of <30.

RESULTS: All cases of colectomy were successfully performed with standard laparoscopic instruments through a single periumbilical incision. For 3 of 6 patients (50%), one additional trocar was inserted to help to grasp the bowel. The SILC procedure was performed with a mean incision length of 4.0 ± 1.0 cm (range, 3.0-5.0 cm) and a mean operative time of 240.9 ± 48.8 min (range, 190-290 min). The mean operative blood loss was 44.3 ± 22.5 ml and the overall mean hospital stay was 11.7 ± 1.3 days (range, 10-13 days). There were no intraoperative complications or conversions to the standard laparoscopic procedure. All patients recovered uneventfully.

CONCLUSIONS: Our preliminary results show that single incision laparoscopic colectomy is feasible and safe for early colon cancers. It can be performed without specialized instrumentation and at no extra cost. However, randomized experiences are required to demonstrate the benefits of SILC compared with standard laparoscopic resections.