Advantages of the Split-leg Supine position Single-port plus one laparoscopic Surgery Approach

Abstract

Background: The goal of this study was to compare the advantages of CLS and SSP SILS+1 in esophageal surgery. Methods: This study enrolled 73 patients who previously underwent radical esophagectomy for esophageal cancer from August 2021 to February 2023. Among them, 36 patients underwent SSP SILS+1, whereas the remaining 37 patients underwent conventional laparoscopic surgery (CLS). Surgical time, bleeding volume, number of dissected lymph nodes, incision length, and postoperative abdominal pain score between the two groups of patients were compared using either the Student's t-test or chi-square test. Results: Time of abdominal incision (1.4±0.2 min vs. 5.2±0.7 min，p<0.001) and bleeding volume (7.0±3.0 mL vs. 8.0±4.0mL，p<0.001) were significantly lower in patients in the SSP SILS+1 group compared with those in the CLS group. However, the average incision length was shorter in the SSP SILS+1 group compared with that in the CLS group (35.4±4.0 cm vs 4.6±4.1 cm, p<0.001). Notably, the pain score on postoperative day (POD) 1 was significantly lower in the SSP SILS+1 group compared with that in the CLS group (5.7±0.7 vs.6.3±0.7，p=0.001). The SCAR score was alsovsignificantly lower in the SSP SILS+1 group compared with that in the CLS group (3.5±0.9 vs 8.3±1.4, p=0.019). There was no significant difference in the number of dissected abdominal lymph nodes and positive lymph nodes (p>0.01) between the two groups. Conclusion: The SSP SILS+1 intervention offers multiple benefits over conventional surgical procedures, encompassing shorter incision length and pain scores on POD 1. In accelerated rehabilitation surgery for esophageal cancer, this surgical procedure demonstrated high safety, feasibility.