ORIGINAL ARTICLE
Single-incision Laparoscopic Surgery for Colon and Rectal Cancer: An Initial Experience With the Technique Iva´n Arteaga Gonza´lez, MD, Antonio Martı´n Malago´n, MD, Sara Gonzalez Garcia, MD, Eudaldo M. Lopez-Tomassetti Ferna´ndez, MD, and Angel Carrillo Pallares, MD, PhD
Background: Single-incision laparoscopic surgery seems destined to take its place in the evolution of minimally invasive surgery. Although isolated cases have been reported in the literature, no series has yet been published on the use of this approach to treat colorectal cancer. We describe the surgical technique and perioperative outcomes of this approach in 15 patients diagnosed for colorectal cancer. Methods: We have used several devices to gain transumbilical access to the abdominal cavity, usually working with 3 cannulae to insert the instruments. We used a 5 mm endograsper, and articulated rotating (roticulating) endoscissors and endodissector to assist dissection. Vascular control and section of the rectum were performed using roticulating endostaplers. We combined the use of curved and straight instruments as required for each step during surgery. The dissection technique performed was the same as the one we normally use in conventional laparoscopy. Specimens were extracted through the umbilical incision. Results: The most commonly performed procedure was sigmoidectomy (n = 7), followed by high anterior resection of the rectum (n = 5). The mean surgical time was 185 ± 44.9 minutes. The mean hospital stay was 6.2 ± 4.7 days. Three cases (20%) were converted to conventional laparoscopy. Surgery was curative in all of the patients. Conclusions: Single-access transumbilical laparoscopic surgery is feasible and safe for treating colorectal carcinoma when performed by surgeons with ample experience in laparoscopic colorectal resection. Further studies are needed to determine the advantages and drawbacks of this procedure. Key Words: minimally invasive surgery, SILS, laparoscopy, colorectal cancer
(Surg Laparosc Endosc Percutan Tech 2013;23:494–497)
R
ecent years have seen the advent of natural orifice surgery and single-incision surgery as a development of minimally invasive surgery. The aim of these procedures is to reduce aggression to the abdominal wall, improving cosmesis and reducing postoperative pain. Initial enthusiasm for NOTES has been dampened by a lack of adequate instruments, by difficulties for achieving safe stomach closure and due to the overall difficulty of the pure procedures involved, and single-incision laparoscopic surgery (SILS) is now viewed by some researchers as an easier intermediate step.1,2
Received for publication August 15, 2012; accepted October 16, 2012. From the Department of Gastrointestinal Surgery, Hospital Universitario de Canarias, La Laguna, Tenerife, Spain. The authors declare no conflicts of interest. Reprints: Eudaldo M. Lopez-Tomassetti Ferna´ndez, MD, Department of Gastrointestinal Surgery, Hospital Universitario de Canarias, La Laguna, Tenerife 38320, Spain (e-mail: [email protected]). Copyright r 2013 by Lippincott Williams & Wilkins
494 | www.surgical-laparoscopy.com
SILS has shown to be effective in uncomplicated appendectomies and cholecystectomies,3,4 and has recently been reported in more complicated procedures, such as splenectomy and bariatric surgery.5,6 However, no series has yet been published on its use in colorectal cancer treatment. We describe the technique followed in 15 patients with colorectal cancer in different locations who underwent surgery with curative intent.
MATERIALS AND METHODS Laparoscopy is the procedure of choice in our center for all colorectal tumors except in patients with signs or symptoms of perforation or obstruction, palpable masses, tumors infiltrating neighboring organs, or recurrent tumors, or in patients with prior colectomies and candidates for local endoanal surgery. Patients selected for single-access surgery were referred from the screening program with tumors endoscopically considered to be early-stage or endoscopically advanced tumors found to be small in preoperative computed tomography. Patients with tumors located in the hepatic and splenic flexures of the colon or
Single-incision Laparoscopic Surgery for Colon and Rectal Cancer: An Initial Experience With the Technique Iva´n Arteaga Gonza´lez, MD, Antonio Martı´n Malago´n, MD, Sara Gonzalez Garcia, MD, Eudaldo M. Lopez-Tomassetti Ferna´ndez, MD, and Angel Carrillo Pallares, MD, PhD
Background: Single-incision laparoscopic surgery seems destined to take its place in the evolution of minimally invasive surgery. Although isolated cases have been reported in the literature, no series has yet been published on the use of this approach to treat colorectal cancer. We describe the surgical technique and perioperative outcomes of this approach in 15 patients diagnosed for colorectal cancer. Methods: We have used several devices to gain transumbilical access to the abdominal cavity, usually working with 3 cannulae to insert the instruments. We used a 5 mm endograsper, and articulated rotating (roticulating) endoscissors and endodissector to assist dissection. Vascular control and section of the rectum were performed using roticulating endostaplers. We combined the use of curved and straight instruments as required for each step during surgery. The dissection technique performed was the same as the one we normally use in conventional laparoscopy. Specimens were extracted through the umbilical incision. Results: The most commonly performed procedure was sigmoidectomy (n = 7), followed by high anterior resection of the rectum (n = 5). The mean surgical time was 185 ± 44.9 minutes. The mean hospital stay was 6.2 ± 4.7 days. Three cases (20%) were converted to conventional laparoscopy. Surgery was curative in all of the patients. Conclusions: Single-access transumbilical laparoscopic surgery is feasible and safe for treating colorectal carcinoma when performed by surgeons with ample experience in laparoscopic colorectal resection. Further studies are needed to determine the advantages and drawbacks of this procedure. Key Words: minimally invasive surgery, SILS, laparoscopy, colorectal cancer
(Surg Laparosc Endosc Percutan Tech 2013;23:494–497)
R
ecent years have seen the advent of natural orifice surgery and single-incision surgery as a development of minimally invasive surgery. The aim of these procedures is to reduce aggression to the abdominal wall, improving cosmesis and reducing postoperative pain. Initial enthusiasm for NOTES has been dampened by a lack of adequate instruments, by difficulties for achieving safe stomach closure and due to the overall difficulty of the pure procedures involved, and single-incision laparoscopic surgery (SILS) is now viewed by some researchers as an easier intermediate step.1,2
Received for publication August 15, 2012; accepted October 16, 2012. From the Department of Gastrointestinal Surgery, Hospital Universitario de Canarias, La Laguna, Tenerife, Spain. The authors declare no conflicts of interest. Reprints: Eudaldo M. Lopez-Tomassetti Ferna´ndez, MD, Department of Gastrointestinal Surgery, Hospital Universitario de Canarias, La Laguna, Tenerife 38320, Spain (e-mail: [email protected]). Copyright r 2013 by Lippincott Williams & Wilkins
494 | www.surgical-laparoscopy.com
SILS has shown to be effective in uncomplicated appendectomies and cholecystectomies,3,4 and has recently been reported in more complicated procedures, such as splenectomy and bariatric surgery.5,6 However, no series has yet been published on its use in colorectal cancer treatment. We describe the technique followed in 15 patients with colorectal cancer in different locations who underwent surgery with curative intent.
MATERIALS AND METHODS Laparoscopy is the procedure of choice in our center for all colorectal tumors except in patients with signs or symptoms of perforation or obstruction, palpable masses, tumors infiltrating neighboring organs, or recurrent tumors, or in patients with prior colectomies and candidates for local endoanal surgery. Patients selected for single-access surgery were referred from the screening program with tumors endoscopically considered to be early-stage or endoscopically advanced tumors found to be small in preoperative computed tomography. Patients with tumors located in the hepatic and splenic flexures of the colon or
