Single-port laparoscopic total proctocolectomy with ileal pouch-anal anastomosis: initial operative experience

Single-port laparoscopic surgery (SPLS) has been used in urologic, gynecologic, general, and colorectal surgery. We herein report our experience with the use of SPLS for total proctocolectomy with ileal pouch-anal anastomosis (RP/IPAA).

All patients who underwent a RP/IPAA using SPLS between June and September 2009 were identified from a prospectively maintained laparoscopic database. All procedures were performed with the use of a 5-mm Olympus EndoEye™ and traditional laparoscopic instruments via a SILS™ port placed at the planned ileostomy site.

There were five patients (3 male) included in the study. Median age was 43 years (range=13-47 years). Median body mass index was 20.66 kg/m2 (range=14.63-25.97 kg/m2). Diagnoses included ulcerative colitis (n=4) and familial adenomatous polyposis (n=1). Median ASA score was 2 (range=1-3). Median operative time was 153 min (range=132-278 min). Median estimated blood loss was 100 ml (range=50-200 ml). There were no conversions to either a conventional laparoscopic or an open procedure. Median time to return of bowel function was 2 days. Median length of stay was 4 days (range=3-6 days). Postoperative complications included two patients with partial small-bowel obstructions. Both resolved with conservative management. All patients had their ileostomies closed.

RP/IPAA using SPLS is a safe technique. Additional studies are needed to compare SPLS to conventional laparoscopy and open surgery with respect to operative times, convalescence, and outcomes.