Single site laparoscopic right hemicolectomy: an oncological feasible option
© Lim et al; licensee BioMed Central Ltd. 2010
Received: 12 August 2010
Accepted: 8 September 2010
Published: 8 September 2010
We present the first 7 cases of single site right hemicolectomy in Asia using the new Single Site Laparoscopy (SSL) access system from Ethicon Endo-surgery.
Right hemicolectomy was performed using the new Single Site Laparoscopy (SSL) access system. Patient demographics, operative time, histology and post operative recovery and complications were collected and analysed.
The median operative time was 90 mins (range 60 - 150 mins) and a median wound size of 2.5 cm (range 2 to 4.5 cm). The median number of lymph nodes harvested was 24 (range 20 to 34 lymph nodes). The median length of proximal margin was 70 mm (range 30 to 145 mm) and that of distal margin was 50 mm (35 to 120 mm). All patients had a median hospital stay of 7 days (range 5 to 11) and there were no significant perioperative complications except for 1 patient who had a minor myocardial event.
Right hemicolectomy using SSL access system is feasible and safe for oncologic surgery.
Since the advent of laparoscopy, there have been advances and interest in minimizing the size and number of access sites. With the development of technical skills, more surgeons are trained and are comfortable doing laparoscopic colectomies, the next progression would be to make surgery less invasive without compromising safety. Minimally invasive colectomies have evolved with hand-assisted laparoscopic, conventional laparoscopic and possibly Natural Orifice Transluminal Endoscopic Surgery (NOTES) in the future. Single site laparoscopic surgery lies between conventional laparoscopic and NOTES, and aims to combine the advantages of both approaches . Here, we used the umbilicus, an embryologically natural orifice as the sole access in performing right hemicolectomy for our series of patients, which is the first in Asia using the latest SSL access system.
Postoperatively, the patients had a median pain score of 2(out of 10) on the day of the operation, and a score of 2 on the 1st postoperative day. All had no significant pain after the 2nd post-operative day. All patients had a median hospital stay of 7 days (range 5 to 11 days) and there were no significant perioperative complications, other than 1 patient who had a minor myocardial infarct. Specifically, none of the patients had surgical site infection. All patients stayed beyond commencement of bowel function for social reasons.
Single port access right hemicolectomy has been shown to be feasible for oncologic surgery . It may have advantage over conventional laparoscopic surgery in terms of reduced pain, lower cost, faster recovery and cosmesis . There have been many different types of single port access systems, each trying to improve on previous models. Here, we evaluate the latest refinement, which is the SSL access system.
There are several advantages using the new SSL access system. The low profile seal cap enables us to use a wide range of instruments. The integrated system also eliminates the needs for trocars which might interfere with the manipulation of instruments in the abdominal cavity. Furthermore, 360 degrees seal cap rotation allows quick reorientation of instruments throughout the surgery without requiring instrument exchanges. At the end of the procedure, the retractor of the SSL access system also serves as a wound protector during specimen retrieval.
Here, we also demonstrate that single port right hemicolectomy is feasible with a reasonable operative time (median 90 mins), and no significant perioperative complications. Based on the histopathological report, there were adequate lymph nodes (median 24 lymph nodes) and resection margins (median proximal 70 mm, distal 50 mm) from the resected specimens. Our results are comparable to other case reports and case series in the literature [5–7], which have reported operative time ranging from 115 to 255 mins.
In terms of patient preference, single port appendicectomy has been shown to be the most favoured method over open, conventional laparoscopic and NOTES, extrapolating, perhaps this may be the approach to invest in  for laparoscopic colectomies in the future.
Right hemicolectomy using SSL access system is feasible and safe for oncologic surgery. It has encouraging results in terms of operating time and postoperative pain score. The favourable results thus far suggest this may be the direction for the future of minimally invasive colorectal surgery.
- Wong MT, Ng KH, Ho KS, Eu KW: Single-incision laparoscopic surgery for right hemicolectomy: our initial experience with 10 cases. Tech Coloproctol. 2010, 14 (3): 225-228. 10.1007/s10151-010-0596-x.View ArticlePubMedGoogle Scholar
- Bucher P, Pugin F, Morel P: Single port access laparoscopic right hemicolectomy. Int J Colorectal Dis. 2008, 23 (10): 1013-1016. 10.1007/s00384-008-0519-8.View ArticlePubMedGoogle Scholar
- Choi SI, Lee KY, Park SJ, Lee SH: Single port laparoscopic right hemicolectomy with D3 dissection for advanced colon cancer. World J Gastroenterol. 2010, 16 (2): 275-278. 10.3748/wjg.v16.i2.275.PubMed CentralView ArticlePubMedGoogle Scholar
- Chambers W, Bicsak M, Lamparelli M, Dixon A: Single-incision laparoscopic surgery (SILS) in complex colorectal surgery: a technique offering potential and not just cosmesis. Colorectal Dis. 2009,Google Scholar
- Ramos-Valadez DI, Patel CB, Ragupathi M, Bartley Pickron T, Haas EM: Single-incision laparoscopic right hemicolectomy: safety and feasibility in a series of consecutive cases. Surg Endosc. 2010,Google Scholar
- Remzi FH, Kirat HT, Kaouk JH, Geisler DP: Single-port laparoscopy in colorectal surgery. Colorectal Dis. 2008, 10 (8): 823-826. 10.1111/j.1463-1318.2008.01660.x.View ArticlePubMedGoogle Scholar
- Uematsu D, Akiyama G, Magishi A, Nakamura J, Hotta K: Single-access laparoscopic left and right hemicolectomy combined with extracorporeal magnetic retraction. Dis Colon Rectum. 2010, 53 (6): 944-948.View ArticlePubMedGoogle Scholar
- Rao A, Kynaston J, Macdonald ER, Ahmed I: Patient preferences for surgical techniques: should we invest in new approaches?. Surg Endosc. 2010,Google Scholar
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