Single-port laparoscopic colorectal surgery shows equivalent or better outcomes to standard laparoscopic surgery: results of a 190-patient, 7-criterion case-match study

Introduction. Hand-assisted laparoscopic surgery (HALS) was introduced into clinical practice in the mid-1990s. Although this technique was established as a bridge to total laparoscopic colorectal surgery there are still those who oppose it. In this study we report our 10 year experience of practicing HALS. Methods. This study is a retrospective analysis of prospectively collected data of 426 patients undergoing hand-assisted laparoscopic colorectal surgery for left-sided colon and rectal cancer in a single tertiary care institution, the National Cancer Institute, from January, 2006, to July, 2016. All consenting patients with left sided colon and rectal cancer were included in the analysis. Results. Patient population showed a similar female and male ratio 212 (49.76%) vs. 214 (50.24%). Average age was 64.13 ? 9.92 years (from 26 to 91). Operation time was 108 minutes ? 44.1 min (30 - 320 min). The mean length of the postoperative hospital stay was 6.88, ranging from 2 to 34 days. The pathohistological examination revealed mean lymph node harvest was 16.4 ? 9.61, ranging from 0 to 54. Stage I and II cancer prevailed in the majority of cases, accounting for 129 (30.28%) for each, stage III - 135 (31.69%), and stage IV - 33 (7.74%). Complication rate was 7.27%. Surgical reintervention was required in 10 cases (2.35%). Mortality rate occurred only in two (0.47%) patients. Conclusion. In conclusion, the HALS technique combines the benefits of a minimal invasive technique for the patient and palpatory benefits for the surgeon, which makes surgery for left-sided colon and rectum cancer faster, and with a similar outcome to laparoscopic colectomy.

Download Full-text

The Introduction of Laparoscopic Colorectal Surgery: Can It Improve Hospital Economics?

Digestive Surgery ◽

10.1159/000511180 ◽

2020 ◽

pp. 1-8

Author(s):

Martijn Maassen van den Brink ◽

Thaís T.T. Tweed ◽

Patrick A. de Hoogt ◽

A.G.M. Hoofwijk ◽

Karel W.E. Hulsewé ◽

...

Keyword(s):

Laparoscopic Surgery ◽

Colorectal Surgery ◽

Laparoscopic Colorectal Surgery ◽

Operating Time ◽

Median Hospital Stay ◽

Total Cost ◽

Hospital Economics ◽

Financial Benefits ◽

Clinical Benefits ◽

Improve Hospital

Introduction: Clinical benefits of laparoscopic surgery are well established, but evidence for financial benefits is limited. This study aimed to compare the financial impact of the introduction of laparoscopic colorectal surgery. Methods: This study included patients who underwent colorectal surgery between January 2010 and 2015. We collected a range of financial data and divided the patients into 2 groups. Primary outcome was total cost defined by surgical-related costs. Results: A total of 1,246 patients were included, of which 440 surgeries were performed laparoscopically. The total median cost of laparoscopy was higher compared to open surgery (EUR 4,665 vs. EUR 4,268, p = 0.001). Laparoscopy was associated with higher equipment costs (EUR 857 vs. EUR 232, p < 0.001), longer operating time (3.2 vs. 2.5 hours, p < 0.001), and more readmissions (10.9 vs. 8.5%, p < 0.001). However, after adjusting for heterogeneity, no difference was found in total cost. Surgical-related costs were counterbalanced by lower costs associated with shorter median hospital stay (6 vs. 9 days, p < 0.001), less morbidity (37.3 vs. 55.1%, p < 0.001), and less mortality (1.8 vs. 5.6%, p = 0.013) for laparoscopy. Conclusion: During the introduction of laparoscopy for colorectal surgery, no significant differences were found in total cost between laparoscopic and open colorectal surgery. However, favorable postoperative outcomes were achieved with laparoscopic surgery.

Download Full-text

Commentary on “Single-Port Laparoscopic Colorectal Surgery: Early Clinical Experience”

Journal of Laparoendoscopic & Advanced Surgical Techniques ◽

10.1089/lap.2012.9989 ◽

2012 ◽

Vol 22 (9) ◽

pp. 858-858 ◽

Cited By ~ 1

Author(s):

Philip P. Metzger

Keyword(s):

Colorectal Surgery ◽

Clinical Experience ◽

Single Port ◽

Laparoscopic Colorectal Surgery ◽

Early Clinical Experience

Download Full-text

Persistent Descending Mesocolon as a Risk Factor of Laparoscopic Surgery for Colorectal Cancer: A Single Institution Experience

International Surgery ◽

10.9738/intsurg-d-16-00085.1 ◽

2019 ◽

Vol 104 (9-10) ◽

pp. 439-445

Author(s):

Hidekazu Takahashi ◽

Nobuo Tanaka ◽

Osamu Takayama ◽

Masashi Baba ◽

Masaru Murata ◽

...

Keyword(s):

Colorectal Cancer ◽

Risk Factors ◽

Laparoscopic Surgery ◽

Colorectal Surgery ◽

Laparoscopic Colorectal Surgery ◽

Three Dimensional ◽

Tumor Location ◽

Computed Tomographic ◽

Preoperative Diagnostic ◽

Tomographic Slice

The objectives of this study are to clarify the significance of persistent descending mesocolon (PDM), a kind of intestinal malrotation, in laparoscopic colorectal surgery and present potentially useful preoperative diagnostic methods for PDM. Although several risk factors for laparoscopic colorectal surgery have been convincingly reported, the impact of PDM on laparoscopic surgery for colorectal cancer remains less studied. This was an observational study with a retrospective analysis. A consecutive 110 patients undergoing laparoscopic colorectal surgery for colorectal cancer were included. To identify risk factors for operative time of laparoscopic surgery for colorectal cancer, we examined age, sex, body mass index, American Society of Anesthesiologists Performance Status score, tumor location, depth of tumor invasion, lymph node metastasis, and PDM as potential risk factors. For identification of appropriate preoperative diagnostic imaging, we reviewed three-dimensional vessel images reconstructed from computed tomographic slice data of all patients. During the study period, no effective pre- or intraoperative diagnoses of PDM were achieved. A total of 4 patients were diagnosed with PDM. Sex (P = 0.0032); tumor location (P = 0.0044); lymph node metastasis (P = 0.022); and PDM (P = 0.0007) were identified as risk factors based on multivariate analysis. A ventrally branched left colic artery visualized by three-dimensional imaging appeared to be a highly specific feature of PDM. Laparoscopic surgery for colorectal cancer with PDM was difficult without the recognition of PDM. PDM was well-defined preoperatively using three-dimensional vessels images reconstructed from computed tomographic slice data.

Download Full-text

Single-Port Laparoscopic Colorectal Surgery: Early Clinical Experience

Journal of Laparoendoscopic & Advanced Surgical Techniques ◽

10.1089/lap.2012.0278 ◽

2012 ◽

Vol 22 (9) ◽

pp. 853-857 ◽

Cited By ~ 6

Author(s):

Salman Al Sabah ◽

A. Sender Liberman ◽

MingKwan Wongyingsinn ◽

Patrick Charlebois ◽

Barry Stein ◽

...

Keyword(s):

Colorectal Surgery ◽

Clinical Experience ◽

Single Port ◽

Laparoscopic Colorectal Surgery ◽

Early Clinical Experience

Download Full-text

Single-Port Laparoscopic Surgery for Inflammatory Bowel Disease

Minimally Invasive Surgery ◽

10.1155/2012/106878 ◽

2012 ◽

Vol 2012 ◽

pp. 1-20 ◽

Cited By ~ 3

Author(s):

Emile Rijcken ◽

Rudolf Mennigen ◽

Norbert Senninger ◽

Matthias Bruewer

Keyword(s):

Inflammatory Bowel Disease ◽

Laparoscopic Surgery ◽

Surgical Treatment ◽

Bowel Disease ◽

Single Port ◽

Operative Techniques ◽

Short Term ◽

Inflammatory Bowel ◽

Pouch Reconstruction ◽

Standard Laparoscopic Surgery

Background. Single Port Laparoscopic Surgery (SPLS) is being increasingly employed in colorectal surgery for benign and malignant diseases. The particular role for SPLS in inflammatory bowel disease (IBD) has not been determined yet. In this review article we summarize technical aspects and short term results of SPLS resections in patients with Crohn's disease or ulcerative colitis.Methods. A systematic review of the literature until January 2012 was performed. Publications were assessed for operative techniques, equipment, surgical results, hospital stay, and readmissions.Results. 34 articles, published between 2010 and 2012, were identified reporting on 301 patients with IBD that underwent surgical treatment in SPLS technique. Surgical procedures included ileocolic resections, sigmoid resections, colectomies with end ileostomy or ileorectal anastomosis, and restorative proctocolectomies with ileum-pouch reconstruction. There was a wide variety in the surgical technique and the employed equipment. The overall complication profile was similar to reports on standard laparoscopic surgery in IBD.Conclusions. In experienced hands, single port laparoscopic surgery appears to be feasible and safe for the surgical treatment of selected patients with IBD. However, evidence from prospective randomized trials is required in order to clarify whether there is a further benefit apart from the avoidance of additional trocar incisions.

Download Full-text

The single-incision laparoscopic surgery technique has questionable advantages in colorectal surgery

Innovative Surgical Sciences ◽

10.1515/iss-2017-0048 ◽

2018 ◽

Vol 3 (1) ◽

pp. 77-84

Author(s):

Bernd Schneider ◽

Anne Catharina Brockhaus ◽

Marcos Gelos ◽

Claudia Rudroff

Keyword(s):

Laparoscopic Surgery ◽

Colorectal Surgery ◽

Hospital Stay ◽

Single Incision ◽

Laparoscopic Colorectal Surgery ◽

Postoperative Hospital Stay ◽

Colorectal Disease ◽

Single Incision Laparoscopic Surgery ◽

Surgery Technique ◽

Significant Difference

AbstractBackground:Laparoscopic procedures have increasingly been accepted as standard in surgical treatment of benign and malignant entities, resulting in a continuous evolution of operative techniques. Since one of the aims in laparoscopic colorectal surgery is to reduce access trauma, one possible way is to further reduce the surgical site by the single-incision laparoscopic surgery technique (SLS). One of the main criticisms concerning the use of SLS is its questionable benefit combined with its technical demands for the surgeon. These questions were addressed by comparing SLS versus conventional laparoscopic multitrocar surgery (LMS) in benign and malignant conditions with respect to technical operative parameters and early postoperative outcome of the patients.Methods:Between 2010 and 2013, we performed SLS for colorectal disease. Of the 111 patients who underwent colorectal resection, 47 patients were operated by SLS and 31 using the LMS technique. The collected data for our patients were compared according to operating time, postoperative morbidity and mortality, pain score numeric rating scale on day 1 and day 5 postoperatively and postoperative hospital stay. To complement the pain scores, the required pain medication for adequate pain relief on these days was given.Results:There was no significant difference in age, BMI or sex ratio between the two groups. The intraoperative and early postoperative course was comparable as well. Postoperative hospital stay was the only parameter with a significant difference, showing an advantage for SLS.Conclusion:SLS is a feasible surgical method and a technical option in laparoscopic colorectal surgery. However, we were not able to identify substantial advantages of SLS that would favor this technique.

Download Full-text