Single-incision laparoscopic surgery using colon-lifting technique for colorectal cancer: a matched case–control comparison with standard multiport laparoscopic surgery in terms of short-term results and access instrument cost

Fujii, Satoshi; Watanabe, Kazuteru; Ota, Mitsuyoshi; Watanabe, Jun; Ichikawa, Yasushi; Yamagishi, Shigeru; Takagi, Kenji; Suwa, Hirokazu; Kunisaki, Chikara; Taguri, Masataka; Morita, Satoshi; Endo, Itaru

doi:10.1007/s00464-011-2047-9

Cited by 41 publications

(17 citation statements)

References 37 publications

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“…The literature search identified one randomized contro lled trial and 13 cased-matched control or comparative studies [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] . In total, 1559 colorectal resections were included, 589 by SILC and 970 by CLC.…”

Section: Resultsmentioning

confidence: 99%

Single-incision laparoscopic surgery for colorectal cancer

Hirano

Hattori

Douden

et al. 2016

WJGS

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Section: Resultsmentioning

confidence: 99%

Single-incision laparoscopic surgery for colorectal cancer

Hirano

Hattori

Douden

et al. 2016

WJGS

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“…Therefore, the shorter length of the umbilical incision does not increase the difficulty of RPS in terms of laparoscopic handling. Fujii et al (13) reported that the median length of the skin incision was 3.3 cm in SILS for CRC, and Hachisuka et al (14) reported on the zigzag skin incision in RPS for CRC. An incision was required from above to below the umbilical ring.…”

Section: Discussionmentioning

confidence: 99%

Z skin incision in reduced-port surgery for colorectal cancer

Fujino

Miyoshi

Ohue

et al. 2016

Molecular and Clinical Oncology

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Abstract. Laparoscopic surgery for colorectal cancer (CRC) has recently gained in popularity due to the fewer trocars and shorter incision, leading to reduced wound pain and improved cosmetic outcome. In July, 2013, reduced-port surgery (RPS) was introduced and has been performed thereafter in our hospital. An umbilical incision is used for a main port in RPS, through which the specimen is removed and the anastomosis is performed. In order to make the incision shorter, we introduced the Z skin incision in RPS. In this study, we aimed to discuss this method and evaluate the short-term outcome. Among CRC patients undergoing RPS, Z skin incision (n=14) was compared to conventional skin incision (n=15). The clinical and surgical factors were evaluated and there were no significant differences in terms of gender, age, body mass index, tumor site, procedure, operative time, blood loss or complications between the two groups. The median incision length at the umbilicus was significantly shorter in the Z incision group (P=0.004). Particularly in functional end-to-end anastomosis, the median incision length was 2.5 cm in the Z skin incision group and 4.0 cm in the conventional incision group (P=0.018). In conclusion, Z skin incision is a useful technique for achieving an effective length of skin incision in RPS for CRC. IntroductionIn recent years, laparoscopic surgery has been widely performed for colorectal cancer (CRC) in a number of institutions. It has been reported that the efficacy of laparoscopic surgery is due to the reduced blood loss, shorter hospital stay, decreased postoperative pain, earlier postoperative recovery and improved quality of life, with oncological outcomes comparable to those with open surgery (1-3). Conventional multiport laparoscopic surgery for CRC is mainly performed using five trocars, namely one for the laparoscopist, two for the operator and two for the assistant. Recently, efforts have been made to reduce the number of trocars and perform a shorter skin incision, in order to reduce wound pain and provide a better cosmetic outcome; therefore, single-incision laparoscopic surgery (SILS) and reduced-port surgery (RPS) have been applied in colectomies (3-7). In SILS and RPS, an umbilical incision is used for multi-trocar access, to remove the specimen and perform the anastomosis; thus, the length of the umbilical skin incision depends on these procedures. A shorter umbilical skin incision may reduce postoperative pain and provide a better cosmetic outcome. A Z-shaped skin incision has been used in orthopedics and plastic surgery (8). The Z-shaped skin incision is used for the relaxation of scar contractures and it may provide an incision that is longer compared with a straight line (9). We attempted to perform a shorter umbilical incision using this method and we herein report the usefulness of the Z skin incision in RPS for CRC. Patients and methods Patients.A total of 33 patients underwent RPS for CRC at the Osaka Medical Center for Cancer and Cardiovascular Diseases (Osaka, Japan) betwee...

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“…Fully tilting the patient toward the right side of the reverse Trendelenburg position using gravity and a transparietal sling suture may facilitate counterattraction to overcome the lack of triangulation [11,14,21]. …”

Section: Discussionmentioning

confidence: 99%

“…Recently, single incision laparoscopic surgery (SILS) for reducing laparoscopic ports and minimizing the potential risks of trocar related complications has emerged as a novel technique, and has been applied to colorectal surgery [7,8,9,10,11,12]. …”

Section: Introductionmentioning

confidence: 99%

Single incision laparoscopic colectomy for colorectal cancer: comparison with conventional laparoscopic colectomy

Lim

Kim

2014

Ann Surg Treat Res

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PurposeThe aim of this retrospective study was to evaluate the feasibility of single incision laparoscopic surgery (SILS), and to compare the short-term surgical outcomes with those of conventional laparoscopic surgery for colorectal cancer.MethodsForty-four patients who underwent SILS were compared with 263 patients who underwent conventional laparoscopic surgery for colorectal adenocarcinoma between November 2011 and September 2012.ResultsIn the SILS group, eleven cases (25.0%) of right hemicolectomy, 15 (34.1%) anterior resections, and 18 (40.9%) low anterior resections were performed. Additional ports were required in 10 rectal patients during SILS operation. In the 32 patients with rectosigmoid and rectal cancer in the SILS group, patients with mid and lower rectal cancers had a tendency to require a longer operation time (168.2 minutes vs. 223.8 minutes, P = 0.002), additional ports or multiport conversion (P = 0.007), than those with rectosigmoid and upper rectal cancer. Both SILS and conventional groups had similar perioperative outcomes. Operation time was longer in the SILS group than in the conventional laparoscopic surgery group (185.0 minutes vs. 139.2 minutes, P < 0.001). More diverting stoma were performed in the SILS group (64.7% vs. 24.2%, P = 0.011). Multivariate analysis showed that tumor location in the rectum (95% confidence interval [CI], 1.858-10.560; P = 0.001), SILS (95% CI, 3.450-20.233; P < 0.001), diverting stoma (95% CI, 1.606-9.288; P = 0.003), and transfusion (95% CI, 1.092-7.854; P = 0.033) were independent risk factors for long operation time (>180 minutes).ConclusionSILS is a feasible, not inferior treatment option for colorectal cancer, and appears to have similar results as standard conventional multiport laparoscopic colectomy, despite the longer operative time.

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Single-incision laparoscopic surgery using colon-lifting technique for colorectal cancer: a matched case–control comparison with standard multiport laparoscopic surgery in terms of short-term results and access instrument cost

Abstract: SILS performed using CLT was safe and effective in providing radical treatment of cT2N0 cancer in the right-sided colon, sigmoid, or rectosigmoid. SILS was advantageous with respect to cosmesis and lower cost of access instruments.

Cited by 41 publications

References 37 publications

Single-incision laparoscopic surgery for colorectal cancer

Single-incision laparoscopic surgery for colorectal cancer

Z skin incision in reduced-port surgery for colorectal cancer

Single incision laparoscopic colectomy for colorectal cancer: comparison with conventional laparoscopic colectomy

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