Toshimasa Yatsuoka, MD, Yoji Nishimura, MD, Hirohiko Sakamoto, MD, Yoichi Tanaka, MD. Saitama Cancer Center
INTRODUCTION: With increased clinical experience and advances in technology, single incision laparoscopic colectomy (SILC) has become a safe and feasible approach. Progress in this field has been driven by multiple factors. The recent development of various devices to access into the abdomen and miniaturized laparoscopic instruments of 3-mm diameter or less has caused surgeons worldwide to shift towards performing SILC. We present a case control series of twelve cases of SILC using the new access port device (EZ Access) with needlescopic instruments and conventional laparoscopic right colectomy (LAC). The aim of our report was to analyze the safety, techniques and feasibility of this surgical technique for colon cancer patients.
METHODS AND PROCEDURES: Between December 2009 and September 2011, twelve selected patients whose informed consent was obtained underwent SILC. All cases were cT1 or cT2 right side colon adenocarcinomas (from cecum to hepatic flexure). These cases were matched to an equal number of LAC patients based on 5 matching criteria: age, sex, body mass index (BMI), American Society of Anesthesiologists score (ASA) and pathology. All operations were completed by one Japanese board-certified colon and rectal surgeon. A longitudinal umbilical incision was used for all SILC cases using EZ Access to place three ports through the access port device with standard laparoscopic instruments (non-disposable straight instruments) and needlescopic instruments. Demographic data, intraoperative parameters, and postoperative outcomes were assessed.
RESULTS: All cases of SILC procedures were successfully performed with standard and needlescopic laparoscopic instruments through a single umbilical incision. Morbidity was encountered in one patient of twelve patients (0.8 %) and one additional trocar was inserted to help to grasp the bowels or pedicle of vessels in 4 cases (33 %). No significant intraoperative complications occurred and no patients required conversion to standard laparoscopic approach using 5 ports. All patients recovered without issues. At this time no recurrence was identified. Twelve patients were analyzed in each of two groups (SILC and LAC). The mean age, sex, BMI, ASA score and pathology were similar between the groups. The incision length for SILC (4.1 cm) was smaller than LAC (5.6 cm) groups (p _ 0.006) and length of hospital stay was shorter for the SILC group (10.8 days) than LAC groups (12.5 days) (p _ 0.08). Operative time, estimated blood loss and postoperative surgical site infection were similar between the groups.
CONCLUSIONS: Our preliminary study suggests that SILC for right side T1 or T2 colon cancer using EZ Access can be feasible and safe with satisfactory hospital stays and reasonable complication rates. The use of additional needlescopic instruments can facilitate SILC procedures more effectively at no extra cost. Although technology in this field is advancing very rapidly, we must have great necessity to practice new minimal access surgical skills to increase benefit of patients. Further follow-up and RCT trials will be necessary to determine its long-term clinical outcomes.
Session Number: Poster – Poster Presentations
Program Number: P032