Single Incision Laparoscopic Colorectal Surgery for Neoplasia

Dan Geisler, MD Associate Staff. West Penn Allegheny Health System

Compared to open surgery, the benefits afforded to a patient from a minimally invasive approach for colorectal surgical resections are very well documented. The oncologic outcomes of a minimally invasive approach for the treatment of colorectal cancer have been shown to be at least equivalent to that of an open operation. With heightened interest in even less invasive surgery, single incision laparoscopic colorectal surgery is quickly gaining acceptance. While this access technique was first described in 2007 for colorectal resective procedures, large series and indications for its application are lacking.
Between January 2009 and December 2010, all patients undergoing single incision colorectal surgery by a single surgeon were prospectively entered into an IRB-approved database and studied with regards to perioperative and postoperative events, morbidity and mortality.
27 consecutive patients (Age 13-93) underwent single incision laparoscopic colorectal procedures for neoplasia. There were no conversions to an open operation. 7 patients (26%) had previous abdominal surgery and the average BMI was 26.1 (15-38). Five patients (19%) required placement of additional ports (1: N=4; 3: N=1). Primary diagnoses included colon cancer (9), adenoma (8), ulcerative colitis with dysplasia (7), familial adenomatous polyposis (1), rectal cancer (1) and submucosal mass (1). The average operating room time was 100 minutes (46-245) and mean length of incision was 3.7cm (1.2-7.4). Estimated blood loss was 135 mL (10-400). One patient required a peri-operative blood transfusion. Procedures performed included right colectomy (15), total colectomy (5), total proctocolectomy with j-pouch (5), and left colectomy/anterior resection (2). There was no mortality. Overall morbidity was 55%: wound infection (6), ileus (4), atelectasis (4) and urinary retention 1. There were no anastomotic leaks. The mean length of stay was 6 days (3-24). No patients required reoperation. In patients with known cancers, an average of 33 lymph nodes (Range = 13-132) were examined. There were no involved margins.
With proper patient selection and laparoscopic experience, single incision laparoscopic surgery can be performed safely and effectively for neoplasia of the colon and rectum.

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