Single Incision Laparoscopic Resection of Small Bowel Tumors: A Case Series

Terry P Nickerson, MD, Julliane Bingener, MD, Johnathon Aho, MD

Mayo Clinic, Rochester, MN.

Introduction: For small GISTs and carcinoid tumors, the current best treatment is surgical resection. Resection has been described using both open and laparoscopic techniques. Open procedures require a large incision for resection, and laparoscopic procedures require enlarging an incision to allow for specimen removal or intracorporeal anastomosis. In select centers, advanced procedures are being performed using single incision laparoscopic surgery (SILS). We sought to describe our experience with resection of primary small bowel tumors, including small GISTs, Neuroendocrine Carcinomas, and other rare tumors using SILS technique.

Methods: A retrospective review of a single surgeon experience with laparoscopic small bowel resections from 2008-2012. Permission was obtained from an Institutional Review Board. Patients were classified according to type of procedure (i.e. conventional laparoscopy (LAP) and single incision laparoscopic surgery (SILS)).

Results: Ten patients were identified who underwent laparoscopic resection of small bowel tumors and consented to be in the study; nine in the small bowel and one in the cecum. Three small bowel tumors were resected using conventional laparoscopy, with extension of the periumbilical incision to allow externalization of the bowel. The remaining tumors were resected using the SILS technique, with a 3-4 cm periumbilical incision made for placement of the GelPort. The bowel was then externalized through this incision. We found no significant differences in age, gender, OR time, post operative complications, size of tumor, hospital length of stay or narcotic utilization (reported in oxycodone mg after opioid conversion) between the SILS and LAP groups. Median length of stay was 3 days, Median follow up was 16.5 months and no patients had a recurrence. Only one patient developed a complication, a postoperative ileus requiring NGT decompression.

Conclusions: In selected patients, laparoscopic removal of small bowel tumors is both safe and feasible. In specialized centers, SILS remains a good option for removal of these tumors, as long as the entire small bowel can be externalized and visualized. We were able to safely perform multiple small bowel resections through a single, small periumbilical incision. Given the relative rarity of these tumors, our numbers did not demonstrate statistically significant differences in LOS, Narcotic utilization or postoperative complications between the LAP and SILS groups. This procedure is technically easier than standard laparoscopy with intracorporeal anastomosis, and results in fewer incisions than standard laparoscopy with extracorporeal anastomosis. The patient benefits from the laparoscopic approach with a single, small incision.

Session: Poster Presentation

Program Number: P476

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