Single-Incision Laparoscopic Right Colectomy: A Case-Matched Comparison with Standard Laparoscopic and Hand-Assisted Laparoscopic Techniques

Papaconstantinou, Harry T.; Sharp, Nicole E.; Thomas, John K.

doi:10.1016/j.jamcollsurg.2011.02.010

Cited by 99 publications

(70 citation statements)

References 27 publications

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“…We also agree that benefits and outcomes will prove to be at least equivalent and likely superior to traditional laparoscopy, as its superiority to hand-assist surgery has been shown by others [1]. We are now indeed in the process of defining patient selection, disease processes, and limitations of a single-port technique.…”

supporting

confidence: 53%

Author’s reply to V. Fazio’s invited comment on “Single incision laparoscopic colorectal surgery: a single surgeon experience of 102 consecutive cases”

Geisler

Garrett

2011

Tech Coloproctol

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The authors are thankful for the opportunity to address the comments made by Dr. Fazio and by Dr. Bergamaschi regarding our manuscript entitled ''Single Incision Laparoscopic Colorectal Surgery: A Single Surgeon Experience of 102 Consecutive Cases.''The authors greatly appreciate both the insightful comments offered by Dr. Vic Fazio as well as his understanding that single-incision laparoscopic colorectal surgery is in its infancy. We also agree that benefits and outcomes will prove to be at least equivalent and likely superior to traditional laparoscopy, as its superiority to hand-assist surgery has been shown by others [1]. We are now indeed in the process of defining patient selection, disease processes, and limitations of a single-port technique. Further work is in process and results are forthcoming.As far as Dr. Bergamaschi's comments, we agree that institutional review board (IRB) approval should be mandatory for such studies and greatly appreciate Dr. Bergamaschi's acknowledgement that this was indeed the case in our study as we consider it routine. We also agree that there is a need for innovation in surgery and that this must be implemented in accordance with the rules of evidence. However, we cannot agree with his statement that laparoendoscopic single-site surgery (LESS) is neither technically simple nor random. Given the tremendous advances in new technology (Olympus endo-eye flexible tip 5-mm camera and 5-mm energy devices to name a couple), we are now able to perform even complex abdominal operations in an even less invasive fashion. In fact, the ergonomic challenges and time constraints of traditional laparoscopy are often greatly improved with a single-port technique. LESS is nothing more than grouping the ports together and operating through a single incision. Having performed well over 1,000 laparoscopic colorectal procedures primarily through a three-port technique popularized in the United States by John Marks, MD, the transition to single-incision surgery is quite simple. This has become our routine access as it is essentially a three-trocar technique with the grouping of the ports at a single-site. The authors also agree with Dr. Bergamaschi that the goal for innovative advances in surgery should be the improvement of patient benefit as that was the sole purpose of this study while better defining the patient selection, disease processes, and optimal technique. With regard to the actual technique, single-incision laparoscopy is in its infancy while standardized techniques have not yet been defined. However, it remains a three-trocar laparoscopic procedure. As we are now quickly approaching our second 100 cases, much has been learned. With the ports arranged in a triangular configuration directed to the pathology, the camera is best placed through the apical port with a grasper in the surgeon's right hand and the energy device in the left. The same surgical principles that pertain to open surgery and utilized for a traditional laparoscopic approach are strongly adhered to with this access t...

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supporting

confidence: 53%

Author’s reply to V. Fazio’s invited comment on “Single incision laparoscopic colorectal surgery: a single surgeon experience of 102 consecutive cases”

Geisler

Garrett

2011

Tech Coloproctol

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“…Statistically significant decrease in the median LOS between SIL-RH and ML-RH was demonstrated in only two out of seven studies as well as in the meta-analysis from Vettoretto et al [45]. Moreover, a statistically significant difference was also found between SIL-RH and HAL-RH [18]. These findings are further confirmed by the study from Gandhi et al [49], which demonstrated that the mean LOS was significantly shorter in SILC than in HALC patients (P<0.02).…”

Section: Discussionmentioning

confidence: 88%

“…Lim et al [15] demonstrated a median pain score of 2 (pain score range=0-10) on the same day of SIL-RH and a pain score of 2 on the first postoperative day, with all patients having no significant pain after the second postoperative day. Papaconstantinou et al [18], using a visual analogue scale, measured the mean maximum postoperative pain score, which was 4.7±2.0 and 3.8± 2.1 on the first and second postoperative day, respectively, while on discharge, mean maximum pain score was 1. Lin et al [33] reported a mean pain score of 2.8±0.9 (pain score scale range=1-10), while Vestweber et al [30] demonstrated a mean postoperative pain score of 2 (pain score scale range= 0-10).…”

Section: Postoperative Outcomesmentioning

confidence: 99%

Single-Incision Laparoscopic Right Hemi-Colectomy: a Systematic Review

Αποστόλου

Orfanos²,

Papalois

et al. 2015

Indian J Surg

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As surgeons became more adept with laparoscopic colon surgery, other less invasive procedures, such as singleincision laparoscopic right hemi-colectomy (SIL-RH), have been applied. The objective of this study was to evaluate the safety of SIL-RH as well as its intraoperative and postoperative outcomes for right-sided colon diseases. A detailed search in PubMed for citations that included SIL-RH from 2000 to 2014 revealed 21 studies fulfilling the criteria of the present review. A total of 684 patients were analyzed. Of the patients, 50.2 % were men. Mean patient age was 64.8 years. Of the patients, 36.1 % had already undergone an abdominal operation before the performance of SIL-RH, while 69 % of the patients underwent SIL-RH for colon cancer. Relatively low rates of overall morbidity (15 %) and mortality (0.75 %) were reported in the included studies. Mean length of postoperative hospital stay (LOS) was 5.5 days. Bowel motility return had a mean value of 2.8 days. Mean number of harvested lymph nodes (LN) was 19.2 LN. All resection margins were tumorfree. SIL-RH was a safe alternative to multiport laparoscopic right hemi-colectomy (ML-RH) in terms of morbidity and mortality, postoperative gastrointestinal function recovery, LOS, as well as oncological radicalness.

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“…10,11 The use of SILS has been reported in some cases to result in an overall decrease in the postoperative length of stay, 12 a decrease in the maximum pain score immediately after surgery, and better resultant cosmesis versus the standard multiport laparoscopic technique (LAP). 12 However, as some experts have pointed out, many of the published studies to date are anecdotal 10 or retrospective 13 and may be subject to selection bias. As such, the accuracy of the reported data should be questioned.…”

Section: Discussionmentioning

confidence: 99%

Single-Incision Laparoscopic Appendectomy and Dermoid Cyst Enucleation

Champney

Malloy

Chudusama

et al. 2014

CRSLS

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We present a case report describing the outcome of an appendectomy and subsequent ovarian cyst enucleation using a single-incision laparoscopic approach in a 19-year-old patient. In an acute care setting, computed tomography of the abdomen demonstrated findings consistent with early acute appendicitis as well as a complex cystic mass on the right ovary. Pelvic ultrasonography revealed a right ovarian cystic lesion measuring 2.9 cm. There were no intraoperative complications. This case report demonstrates the feasibility of single-incision laparoscopy even when separate pathologic results are encountered and is, to our knowledge, the first report of the use of this technique for simultaneous appendectomy and dermoid cyst enucleation.

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Single-Incision Laparoscopic Right Colectomy: A Case-Matched Comparison with Standard Laparoscopic and Hand-Assisted Laparoscopic Techniques

Cited by 99 publications

References 27 publications

Author’s reply to V. Fazio’s invited comment on “Single incision laparoscopic colorectal surgery: a single surgeon experience of 102 consecutive cases”

Author’s reply to V. Fazio’s invited comment on “Single incision laparoscopic colorectal surgery: a single surgeon experience of 102 consecutive cases”

Single-Incision Laparoscopic Right Hemi-Colectomy: a Systematic Review

Single-Incision Laparoscopic Appendectomy and Dermoid Cyst Enucleation

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