Single Incision Laparoscopic Colorectal Resections

Elie K Chouillard, MD PhD, Andrew Gumbs, MD FACS. On behalf of the Intercontinental Society of Natural Orifice, Endoscopic, and Laparoscopic Surgery (i-NOELS), Poissy, France

Aim: Natural Orifice Translumenal Endoscopic Surgery (NOTES) is an emerging concept in surgical ideology. Many variants have been described including « pure » NOTES, « Hybrid » NOTES, or even endoscopic surgery. Single Incision Laparoscopic Surgery (SILS) has been inspired by the potential advantages of NOTES including less abdominal wall complications, less postoperative pain, faster return to activity, and better cosmesis. This study analyzed the results of our preliminary experience with these new techniques in colorectal surgery.
Methods: All patients were prospectively included after a written informed consent. The Ethical Board of the Hospital approved the study. A single 25 to 35-mm diameter, umbilical (or right lower quadrant) incision was used. Three 5-mm ports (or two 5-mm and one 12-mm) were inserted through a special platform device.
Patients: From January 2009 to December 2010, SILS or NOTES (either hybrid or pure) was attempted in 39 patients. Exclusion criteria comprised mainly prior open abdominal surgery, ASA III status, organ insufficiency, and hemostasis disorders.
Results: The success rate without conversion to laparotomy or additional port sites was 89.7 % (35 patients). Additional procedures included cholecystectomy (5), oophorectomy (4), intraperitoneal chemohyperthermia (2), duodenal resection (1), hysterectomy (1), and atypical liver resection (1). Mortality rate was nil. The overall morbidity rate (mainly minor complications) was 12.8 % (7 complications in 5 patients). One leak occurred after a sigmoidectomy.
Conclusions: SILS and NOTES procedures are safe and feasible in selected patients with colorectal disease, either benign or malignant. Advantages regarding postoperative pain and length of hospital stay could be demonstrated. However, larger scale, studies are needed for further evidence-based analysis, especially regarding oncological outcome.
 

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