Implementation and usefulness of single-access laparoscopic segmental and total colectomy.
OBJECTIVE
Single-access laparoscopic surgery is a recent vogue in the field of minimally invasive colorectal surgery. While selected series have indicated feasibility, we prospectively examined its usefulness for resectional surgery in routine practice.


METHODS
All patients undergoing laparoscopic colorectal resection over a 12-month period were considered for a single-access approach by a single surgical team in a university hospital. This utilized a 'glove' port via a 3-5 cm periumbilical or stomal site incision, with standard rigid laparoscopic instruments then being used.


RESULTS
Of 76 planned laparoscopic colorectal resections, 35 (47%) were performed by this single-incision laparoscopic modality without disruption of theatre list efficiency or surgical training obligations. The mean (range) age and body mass index of these 25 consecutive right-sided resections, eight total colectomies (seven urgent operations) and two anterior resections was 58 (22-82) years and 23.9 (18.6-36.2) kg/m(2) , respectively. The modal postoperative day of discharge was 4. For right-sided resections, the mean (range) postoperative stay in those undergoing surgery for benign disease was 4.0 days, while for those undergoing operation for neoplasia (n=18, mean age 71 years) it was 5.8 days and the average lymph node harvest was 13. Use of the glove port reduced trocar cost by 58% (€60/£53) by allowing the use of trocar sleeves alone without obturators.


CONCLUSIONS
Single-incision laparoscopic surgery is an effective option for abdominal surgery and seems especially suited for laparoscopic-assisted right-sided colonic resections. The glove port technique facilitates procedural frequency and familiarity and proves economically favourable.
Department of Colorectal Surgery, Beaumont Hospital, Dublin, Ireland.
M N
MN
Baig
M
M
Moftah
J
J
Deasy
D A
DA
McNamara
R A
RA
Cahill
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000295:instrumentation / Q000379:methods*; D003110:Colonic Neoplasms / Q000601:surgery*; D005932:Gloves, Surgical; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000601:surgery*; D010535:Laparoscopy / Q000295:instrumentation / Q000379:methods*; D008875:Middle Aged; D019990:Perioperative Care; D011446:Prospective Studies; D016896:Treatment Outcome