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Does single port improve results of laparoscopic colorectal surgery? A propensity score adjustment analysis
Antoine Khayat1, Léon Maggiori1, Eric Vicaut2
1Service de Chirurgie Colorectale, Pôle des Maladies de l'Appareil Digestif, Hôpital Beaujon - Assistance Publique des Hôpitaux de Paris (APHP), Université Paris VII (Denis Diderot), 100 boulevard du Général Leclerc, 92110, Clichy, France.
Background:
The benefit of single-incision laparoscopy (SIL) over conventional multiport laparoscopy (ML) is not demonstrated in colorectal surgery, mainly because of potentially biased reports. The objective of this study was to compare SIL to ML for colorectal resection, using a propensity score (PS) adjusted analysis.
Methods:
From July 2009 to April 2013, 764 patients who underwent 799 colorectal resections by SIL or ML were analyzed. PS was estimated using a logistic regression model.
Results:
Eighty-four colorectal resections were performed using SIL: 43 ileocolic resections, 15 right-sided colectomies, 14 left-sided colectomies, 5 rectal resections, 4 subtotal colectomies, and 3 total proctocolectomies. Intra-operative complications occurred in 3 procedures (4 %), and conversion laparotomy in 10 (12 %). Postoperative mortality was nil and overall morbidity rate was 25 %, including 7 % of major complications. Mean postoperative length of hospital stay was 8 ± 6 (4-47) days. Outcomes of SIL, when compared to those of 715 ML and after PS adjustment, showed no difference in terms of intra-operative complication (p = 0.315), conversion to open surgery (p = 0.387), overall morbidity (p = 0.393), major morbidity (p = 0.381), or length of postoperative hospital stay (p = 0.080). However, the length of hospital stay was significantly shorter after SIL in the right colectomy subgroup (p = 0.001).
Conclusions:
In colorectal surgery, SIL appears to be safe and effective as compared to ML. It can also reduce hospital stay after right colectomy. These results, if confirmed by randomized trials, would validate SIL in colorectal surgery.
Insights
Single-incision laparoscopy (SIL) is safe and effective for colorectal surgery compared to multiport laparoscopy (ML). SIL may reduce hospital stays, particularly for right colectomies, warranting further investigation in randomized trials.
Area of Science:
- Surgical Innovation
- Minimally Invasive Surgery
- Colorectal Surgery
Background:
- The comparative benefit of single-incision laparoscopy (SIL) over conventional multiport laparoscopy (ML) in colorectal surgery remains unclear due to potential reporting bias.
- Objective comparison using propensity score (PS) adjusted analysis is needed.
Purpose of the Study:
- To compare the safety and efficacy of SIL versus ML for colorectal resections.
- To evaluate outcomes including complications and length of hospital stay.
Main Methods:
- A retrospective analysis of 799 colorectal resections (764 patients) performed between July 2009 and April 2013.
- Propensity score (PS) estimation using logistic regression to adjust for confounding factors.
- Comparison of intra-operative complications, conversion rates, postoperative morbidity, and length of hospital stay between SIL and ML groups.
Main Results:
- No significant differences were observed between SIL and ML in intra-operative complications, conversion to open surgery, overall morbidity, or major morbidity after PS adjustment.
- The overall length of hospital stay did not differ significantly between the two groups (p=0.080).
- A significantly shorter length of hospital stay was noted after SIL specifically in the right colectomy subgroup (p=0.001).
Conclusions:
- Single-incision laparoscopy (SIL) demonstrates comparable safety and effectiveness to multiport laparoscopy (ML) in colorectal surgery.
- SIL may offer a reduced hospital stay, particularly for patients undergoing right colectomy.
- Further validation through randomized controlled trials is recommended to solidify the role of SIL in colorectal procedures.
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