title: Single-access laparoscopic rectal resection versus the multiport technique: a retrospective study with cost analysis.
abstract: BACKGROUND
  Single-access laparoscopic surgery is not used routinely for the treatment of colorectal disease. The aim of this retrospective cohort study is to compare the results of single-access laparoscopic rectal resection (SALR) versus multiaccess laparoscopic rectal resection with a mean follow-up of 24 months.
  
  
  METHODS
  This retrospective cohort study enrolled 42 patients. Between January 2010 and June 2012, 21 SALRs were performed. These patients were compared with a group of 21 other patients who had undergone multiport laparoscopic rectal resection. This control group had the same exclusion criteria and patient demographics. Short-term outcomes were reassessed with a mean follow-up of 2 years. Statistical analysis included the Student t test and Fisher's exact test. Finally, we performed a differential cost analysis between the 2 procedures.
  
  
  RESULTS
  Exclusion criteria, patient demographics, and indication for surgery were similar in both groups. The conversion rate was 0% in both groups. There were no intraoperative complications or deaths. Bowel recovery was similar in both groups. No interventions, readmissions, or deaths were recorded at 30 days' follow-up. At a mean follow-up of 24 months, all the patients with a preoperative diagnosis of cancer are still alive and disease free. Considering the selected 3 items, the mean cost per patient for single-access laparoscopic surgery and multiple-access laparoscopic surgery were estimated as 7213 and 7495 Euros, respectively.
  
  
  CONCLUSIONS
  We think that SALR could be performed in selected patients by surgeons with high multiport laparoscopic skills. It is compulsory by law to evaluate outcomes and cost-effectiveness by using randomized controlled trials.
authors.affiliation: General and Mininvasive Surgical Unit, San Camillo Hospital, Trento, Italy Department of Surgical Specialities and Nephrology, University of Naples Federico II, Naples, Italy umbertobracale@gmail.com.
authors.forename: Umberto
authors.initials: U
authors.lastname: Bracale
authors.affiliation: Multidisciplinary Department of Medical, Surgical and Dental Sciences, Second University of Naples, Naples, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Melillo
authors.affiliation: General and Mininvasive Surgical Unit, San Camillo Hospital, Trento, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Lazzara
authors.affiliation: General and Mininvasive Surgical Unit, San Camillo Hospital, Trento, Italy.
authors.forename: Jacopo
authors.initials: J
authors.lastname: Andreuccetti
authors.affiliation: General and Mininvasive Surgical Unit, San Camillo Hospital, Trento, Italy.
authors.forename: Cesare
authors.initials: C
authors.lastname: Stabilini
authors.affiliation: General, Laparoscopic and Robotic Surgical Unit, Monaldi Hospital, Naples, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Corcione
authors.affiliation: General and Mininvasive Surgical Unit, San Camillo Hospital, Trento, Italy.
authors.forename: Giusto
authors.initials: G
authors.lastname: Pignata
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003365:Costs and Cost Analysis; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012002:Rectal Diseases / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies
keywords: Single-incision laparoscopy; laparoscopic surgery; minimally invasive surgery; rectal resection