Single Incision Laparoscopic Surgery (SILS) with Colon Lifting Method for Early Right Sided and Sigmoid Colon Cancer: Comparison of Short-Term Outcomes Between Standard Multiport Laparoscopic Surgery and SILS

Shoichi Fujii, PhD, Kazuteru Watanabe, PhD, Mitsuyoshi Ota, PhD, Kenji Tatsumi, PhD, Hirokazu Suwa, MD, Ten’i Godai, MD, Takashi Oshima, PhD, Hirotoshi Akiyama, PhD, Yasushi Ichikawa, PhD, Chikara Kunisaki Chikara Kunisaki, PhD, Itaru Endo, PhD. Department of Surgery, Gastroenterological Center, Yokohama City University

(Background) There are still many problems on the procedure in SILS, such as an effective counter traction. (Aim) To present the colon lifting method using a suture string and the short-term results (Procedure) The indication of SILS was limited to the right (RC) and sigmoid (SC) colon of T1 of UICC classification. The port was placed only at the navel. A suture string that is penetrated to the mesocolon is lifted and fixed to the abdominal wall. The main nutrient artery is stretched in the mesocolon, so the lymph node dissection can be performed easily by the medial approach. In the sigmoid colon resection, the lifting-up part is moved to the left upper abdominal wall at the anal dissection, thus the anal colon was stretched straightly. Pulling the colon by the forceps to the caudal direction formed the triangle field. (Method) Between 2006 and 2010, short-term results of SILS(S group) were compared with that of multiport (M group), of which background factors were matched. (Result) Fifteen patients (9 RC, 6 SC) were operated by S and 68 (16 RC, 52 SC) by M. There was no difference between two groups’ backgrounds other than the lesion site. There was no difference in the number of dissected lymph nodes (S: M=20:23), operation time (171:179 min.), bleeding (60:7 ml), morbidity (13.3:23.5%) and hospital stay (8.7:10.7days) except for the wound length (3.6:5.4cm, P<0.05). (Conclusion) SILS with colon lifting method might be advantageous in the point that the radical surgery can be performed without increasing ports and incision. Further technical improvements may increase the feasibility of SILS in near future.