Minilaparoscopic colorectal resection: a preliminary experience and an outcomes comparison with classical laparoscopic colon procedures.
BACKGROUND
Laparoscopy has rapidly emerged as the preferred surgical approach for a number of different diseases because it allows for a correct diagnosis and proper treatment. However, it is not being applied in a widespread manner for the management of benign or malignant colorectal disease. Its natural evolution seems to be the development of mini-instruments and optics (diameter, </=5 mm). This study aimed to illustrate retrospectively the results of an initial minilaparoscopic colorectal surgery experience at two different institutions.


METHODS
Between January 2001 and December 2006, a total of 517 patients underwent a laparoscopic colon procedure. Among them, 161 (31.1%) underwent surgery with mini-instruments. The primary end point was the feasibility rate for minilaparoscopic colon resection. The secondary end points were safety and the impact of the technique on the duration of laparoscopy.


RESULTS
No conversion to classical laparoscopy and eight cases converted to the open approach were registered. The rate for major complications was 3.1%, whereas the rate for minor complications ranged as high as 11.8%.


CONCLUSIONS
Even if limited by its retrospective design, the reported experience shows that minilaparoscopic surgery may be a safe and effective approach to colon pathology. The described features make minilaparoscopy a challenging alternative to laparoscopy for colon disease. If proven to be cost effective without undue risk, as long as adequate training is obtained and proper preparation is observed, minilaparoscopy may become a standard surgical approach for selected patients.
Santoro
Em
E
Department of General and Laparoscopic Surgery, Nuovo Regina Margherita Hospital, Rome, Italy.
Agresta
F
F
Veltri
S
S
Mulieri
G
G
Bedin
N
N
Mulieri
M
M
D000328:Adult; D000368:Aged; D003082:Colectomy / Q000009:adverse effects / Q000379:methods*; D003106:Colon / Q000601:surgery; D003108:Colonic Diseases / Q000601:surgery; D003107:Colorectal Surgery / Q000009:adverse effects / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome