Single Incision Laparoscopy As A Standard for Colorectal Resections for Cancer

Elie K Chouillard. PARIS POISSY MEDICAL CENTER

Introduction: The concept of Natural Orifice Translumenal Endoscopic Surgery (NOTES) contributed to the evolvement of single port laparoscopy. Accessing the abdominal cavity solely through the umbilicus shifted laparoscopy from a multiport to a single port procedure. Proponents of this approach to further reduce the invasiveness of laparoscopic surgery with fewer abdominal wall complications, less postoperative pain, faster return to activity, and better cosmesis. This study reports the mid-term results of single port colorectal resections for cancer (sCR) in our institution.

Methods and Procedures: All patients who had single port laparoscopic procedures were prospectively included in a database created in 2009. A single 25 to 35-mm diameter, umbilical (or right or left lower quadrant) incision was used. Three 5-mm ports (or two 5-mm and one 12-mm) were inserted through a special platform device. Exclusion criteria comprised total mesorectal excision, ASA III status, organ insufficiency, and hemostasis disorders.

Results: From January 2009 to December 2014, sCR was attempted in 278 patients (right, left, transverse, total). During the same study period 111 patients were operated either openly or using standard multiport laparoscopy. An analysis of the distribution of the procedures per year is performed.

Regarding patients who had sCR, the success rate without conversion to laparotomy was 89.7 %. Additional procedures included cholecystectomy (24), oophorectomy (10), intraperitoneal chemohyperthermia (8), duodenal resection (2), hysterectomy (7), and atypical liver resection (6). Mortality rate was nil. The overall morbidity rate (mainly minor complications) was 12.8 %. Eleven patients had leaks (3.9 %).

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.