Elie K CHOUILLARD. 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 patients with colon cancer.
Methods: All patients were prospectively included after a written informed consent. The Ethical Board of the Hospital approved the study. All patients with resectable right or Transverse colon cancer could be theoretically included. A single 25 to 35-mm diameter, umbilical incision was used. Three 5-mm ports were inserted through special platform device.
Patients: From January 2009 to September 2010, SILS or NOTES (either hybrid or pure) was attempted in 21 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 90.5 % (19 patients). Additional procedures included cholecystectomy (4), 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 9.5 % (2 patients). No leak and no reoperation occurred.
Conclusions: SILS and NOTES procedures are safe and feasible in selected patients with right colon cancer. 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.
Program Number: P142