After Jacobs  firstly reported successfully laparoscopic colectomy in 1990. Varieties of minimally invasive surgical technique for colorectal surgery were introduced, including total laparoscopic colectomy (TLC), Hand-assisted laparoscopic colectomy (HALC), Single incision laparoscopic colectomy (SILC) and Robotic-assisted laparoscopic colectomy (RALC). Each procedure has different benefits as well as limitations. Most surgeons are now convinced of the benefits of the laparoscopic approach in colorectal surgery [1–4]. While advantages of laparoscopic surgery include shorter postoperative hospital stay, early return of bowel function, and decreased complications. Disadvantages of TLC are multiple-port sites in the abdomen and an additional incision for removing the specimen. HALC is suitable in complex procedures and bulky tumor . Moreover, the learning curve is shorter than TLC . For RALC, the most benefit of this approach is total mesorectal excision for rectal cancer. The limitations of RLAC are the restriction of the surgical field and high operative cost.
SILC is the new emerging technique in the past two years. The initial applications of SILS in gastrointestinal surgery were appendectomy and cholecystectomy. Currently, a plenty of reports proposed of safety and feasibility of this technique [14, 15, 17–19]. In addition, SILC seems to provide improvement in cosmetic result with potential decreased pain by reducing the number of incision[15, 22] and possible fewer incidence of post-operative incisional hernia. This technique may generate lower risk of port-side metastasis in malignant cases (only one incision). Disadvantages of SILC are restriction of movement, limitation of triangulation and the axis of camera parallel to the instruments. All of these problems need to be corrected by using the special camera (30 or 45 degree or flexible scope) or the special articulating instruments.
From our series, we started to perform SILC in the selected patients who had an early stage of colon carcinoma. We used two techniques for SILC, one is using GelPOINT® and the other is multi-fascial puncture technique. Most of the cases, we used the later technique because of the simplification of the instrument and lower cost. The limitation of the movement is not great different by the two techniques. We overcome the restriction of the angle by using the 30-degree camera. The dissection was started from medial to lateral approach. One of the reasons using this approach is natural adhesion of the colon to lateral abdominal wall can help us to hold the colon. In addition, familiarity of anatomic landmark same as traditional total laparoscopic approach is another reason.
We used conventional straight laparoscopic instruments such as endohook and bowel grasper. Some cases, we used vessels sealing instruments for soft tissue dissection. Surprisingly, SILC for right half colectomy and sigmoidectomy with conventional straight instruments were not a difficult procedure. Varieties of the laparoscopic procedures can be performed successfully without conversion and with minimal intraoperative blood loss. The operative time is acceptable for the learning period. The lymph nodes were adequately retrieved. One patient needs long hospital stay because of his underlying disease without any operative complications.