The role of single-incision laparoscopic surgery in abdominal and pelvic surgery: a systematic review

Ahmed, Kamran; Wang, Tim T.; Patel, Vishal; Nagpal, Kamal; Clark, James E.; Ali, Muhammad; Deeba, Samer; Ashrafian, Hutan; Darzi, Ara; Athanasiou, Thanos; Paraskeva, Paraskevas

doi:10.1007/s00464-010-1208-6

Cited by 144 publications

(121 citation statements)

References 113 publications

(148 reference statements)

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“…There was a trend for patients in the LESS TEP group to return to activity earlier, but the difference did not achieve statistical significance (p = 0.07); this result is consistent with the literature showing faster recovery in other settings. 54 …”

Section: Main Findingsmentioning

confidence: 99%

The role of the laparoendoscopic single site totally extraperitoneal approach to inguinal hernia repairs: a review and meta-analysis of the literature

Siddiqui

Kovzel

Brennan

et al. 2014

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Section: Main Findingsmentioning

confidence: 99%

The role of the laparoendoscopic single site totally extraperitoneal approach to inguinal hernia repairs: a review and meta-analysis of the literature

Siddiqui

Kovzel

Brennan

et al. 2014

cjs

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“…36,37 The operation was, therefore, modified to include the Roux-en-Y anastomotic technique, 38 which has the added advantage of decreasing biliary reflux and preventing subsequent gastric cancer risk. 39,40 The vast majority of procedures are performed laparoscopically 41 and demonstrate low postoperative adverse outcomes. A recent multicenter, prospective, observational study 42 revealed an overall operative 30-day mortality to be 0.3%.…”

mentioning

confidence: 99%

Metabolic surgery and cancer

Ashrafian

Ahmed

Rowland

et al. 2010

Cancer

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139

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The worldwide epidemic of obesity and the global incidence of cancer are both increasing. There is now epidemiological evidence to support a correlation between obesity, weight gain, and some cancers. Metabolic or bariatric surgery can provide sustained weight loss and reduced obesity-related mortality. These procedures can also improve the metabolic profile to decrease cardiovascular risk and resolve diabetes in morbidly obese patients. The operations offer several physiological steps, the so-called BRAVE effects: 1) bile flow alteration, 2) reduction of gastric size, 3) anatomical gut rearrangement and altered flow of nutrients, 4) vagal manipulation and 5) enteric gut hormone modulation. Metabolic operations are also associated with a significant reduction of cancer incidence and mortality. The cancer-protective role of metabolic surgery is strongest for female obesity-related tumors; however, the underlying mechanisms may involve both weight-dependent and weight-independent effects. These include the improvement of insulin resistance with attenuation of the metabolic syndrome as well as decreased oxidative stress and inflammation in addition to the beneficial modulation of sex steroids, gut hormones, cellular energetics, immune system, and adipokines. Elucidating the precise metabolic mechanisms of cancer prevention by metabolic surgery can increase our understanding of how obesity, diabetes, and metabolic syndrome are associated with cancer. It may also offer novel treatment strategies in the management of tumor generation and growth. Cancer 2011;117:1788-99. V C 2010 American Cancer Society.KEYWORDS: metabolic surgery, bariatric surgery, cancer, oncology.The worldwide epidemic of obesity and the global incidence of cancer are both increasing. According to the World Health Organization (WHO), obesity is rising by 30 million cases per year, 1 whereas the overall number of new cancer cases will increase by 300,000 cases per year.2 Both obesity and cancer contribute to increased worldwide mortality and healthcare costs. They are now both recognized as global healthcare concerns and have been the subject of worldwide calls to action. 3,4Several treatment strategies have been developed to decrease obesity; these include prevention, lifestyle, behavioral modification, and pharmacotherapy. The weight-loss effects of these strategies have only been marginally successful, 5 and, therefore, a surgical solution has been developed to provide consistent weight loss in severely obese patients. The operations initially titled ''bariatric procedures'' have demonstrated long-term weight loss at more than 15 years after surgery 6,7 ; however in addition, they achieve pronounced metabolic effects including diabetes resolution in the majority of morbidly obese patients. [8][9][10] As a result, these procedures are now considered as ''metabolic'' operations. 10-14The epidemiological association between obesity rates and cancer rates has come under increased scrutiny as there is now evidence to establish obesity as a significant...

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“…Oltmann and colleagues 14 reported that 2 of 39 pediatric patients required conversion from SILA to CLA. A review of the literature by Ahmed and colleagues 15 in 2011 reported that the conversion rate from SILA to CLA in published studies ranged from 0 to 41%.…”

Section: Discussionmentioning

confidence: 99%

Single-incision versus conventional laparoscopic appendectomy in 688 patients: a retrospective comparative analysis

Liang¹,

Hung²,

Wang³

et al. 2014

Can J Surg

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Background: Laparoscopic surgery has become the standard for treating appendicitis. The cosmetic benefits of using single-incision laparoscopy are well known, but its duration, complications and time to recovery have not been well documented. We compared 2 laparoscopic approaches for treating appendicitis and evaluated postoperative pain, complications and time to full recovery. Methods:We retrospectively reviewed the cases of consecutive patients with appendicitis and compared those who underwent conventional laparoscopic appendectomy (CLA) performed using 3 incisions and those who underwent single-incision laparoscopic appendectomy (SILA). During SILA, the single port was prepared to increase visibility of the operative site.Results: Our analysis included 688 consecutive patients: 618 who underwent CLA and 70 who underwent SILA. Postsurgical complications occurred more frequently in the CLA than the SILA group (18.1% v. 7.1%, p = 0.018). Patients who underwent SILA returned to oral feeding sooner than those who underwent CLA (median 12 h v. 22 h, p < 0.001). These between-group differences remained significant after controlling for other factors. Direct comparison of only nonperforated cases, which was determined by pathological examination, revealed that SILA was significantly longer than CLA (60 min v. 50 min, p < 0.001). Patients who underwent SILA had longer in-hospital stays than those who underwent CLA (72 v. 55 h, p < 0.001); however, they had significantly fewer complications (3.0% v. 14.4%, p = 0.006). Conclusion:In addition to its cosmetic advantages, SILA led to rapid recovery and no increase in postsurgical pain or complications.Contexte : La chirurgie laparoscopique est devenue la norme pour le traitement de l'appendicite. Les avantages de la laparoscopie à simple incision au plan esthétique sont bien connus, mais la durée de l'intervention, ses complications et le temps de récupération n'ont pas été adéquatement documentés. Nous avons comparé 2 approches laparoscopiques pour le traitement de l'appendicite et évalué la douleur et les complications postopératoires, de même que le temps de récupération complète.Méthodes : Nous avons passé en revue de manière rétrospective les dossiers de patients consécutifs atteints d'appendicite et comparé ceux qui ont subi une appendicectomie laparoscopique classique (ALC) à 3 incisions à ceux qui ont subi une appendicectomie laparoscopique à simple incision (ALSI). Durant l'ALSI, l'incision était préparée de manière à améliorer la visibilité du champ opératoire.Résultats : Notre analyse a inclus 688 patients consécutifs : 618 qui ont subi une ALC et 70, une ALSI. Les complications postopératoires ont été plus nombreuses dans le groupe soumis à l'ALC qu'à l'ALSI (18,1 % c. 7,1 %, p = 0,018). Les patients soumis à l'ALSI ont repris l'alimentation orale plus rapidement que ceux qui avaient subi une ALC (temps médian 12 h c. 22 h, p < 0,001). Ces différences entre les groupes sont demeurées significatives après incorporation d'autres facteurs. La comparaison directe...

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The role of single-incision laparoscopic surgery in abdominal and pelvic surgery: a systematic review

Cited by 144 publications

References 113 publications

The role of the laparoendoscopic single site totally extraperitoneal approach to inguinal hernia repairs: a review and meta-analysis of the literature

The role of the laparoendoscopic single site totally extraperitoneal approach to inguinal hernia repairs: a review and meta-analysis of the literature

Metabolic surgery and cancer

Single-incision versus conventional laparoscopic appendectomy in 688 patients: a retrospective comparative analysis

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