NEW YORK (Reuters Health) – In selected patients, colectomy can be performed laparoscopically via a single port. However, the advantages of this technique over multiport laparoscopic colectomy seem marginal, according to a report in the Annals of Surgery online November 19.
“SILC (single-incision laparoscopic colectomy) requires further randomized prospective validation to determine if this new technology is cost-efficient and improves short-term outcomes adequately to be recommended as part of routine care,” conclude Dr. Bradley J. Champagne, with University Hospitals Case Medical Center in Cleveland, Ohio, and colleagues.
They note that single-port laparoscopic surgery should offer less incisional trauma and postoperative pain, but this may be offset by longer operative times and higher costs.
Because earlier feasibility studies of SILC have come from single institutions, the authors conducted a study comparing SILC to multiport laparoscopic colectomy (MLC) performed by experienced laparoscopic surgeons at five institutions.
For the study, outcomes in 165 patients undergoing SILC were compared to those in 165 matched patients having a MLC procedure. Operations included right and left hemicolectomy, total colectomy, proctectomy, proctocolectomy with or without ileal J-pouch, and small bowel resection.
Mean operative times were almost the same in the two groups: 135.5 minutes with SILC and 134.3 minutes with MLC, the researchers found. Similarly, the number of complications such as wound infection and ileus were not significantly different between the groups (43 vs 48, respectively).
Mean length of stay was 4.6 days with SILC compared with 4.3 days with MLC, the report indicates, and there no statistical differences in the number of patients converted to laparotomy (4 vs 8) or requiring re-operation (2 vs 5).
In terms of benefit, the mean maximum pain score on day 1 was less in the SILC group than the MLC group – 4.9 versus 5.6 on a 0-10 scale (p=0.043).
While the study demonstrates the feasibility of single-port laparoscopic colectomy, Dr. Champagne and colleagues note that long-term oncologic outcomes, costs, and port site complications also require evaluation. “Prospective randomized trials should be performed before incorporation of this technology into routine surgical care,” they conclude.
Reference:
Ann Surg 2011.
