10-Year Experience with 1700 Single-Incision Laparoscopies

Area of Science:

• Minimally Invasive Surgery
• Surgical Innovation
• Laparoscopic Techniques

Background:

• Single-incision laparoscopy (SIL) has evolved significantly since its inception, gaining traction with advancements in endoscopic surgery.
• Initially explored in the mid-1900s, SIL has been applied across diverse surgical fields including digestive, thoracic, urologic, gynecologic, and pediatric surgery.
• Previous studies have established the feasibility, safety, and effectiveness of SIL.

Purpose of the Study:

• To report the 10-year experience of a single surgeon at a single institution with single-incision laparoscopy (SIL).
• To evaluate the outcomes and complications associated with a large series of abdominal SIL procedures.
• To assess the safety, effectiveness, and cosmetic benefits of SIL in abdominal surgery.

Main Methods:

• A retrospective review of 1700 abdominal SIL procedures performed between May 2009 and May 2019.
• Procedures included a wide range of abdominal surgeries such as cholecystectomy, hernia repair, appendectomy, and colorectal surgery.
• Outcomes evaluated included operative time, blood loss, need for supplementary instruments, incision length, hospital stay, postoperative pain, and early/late complications.

Main Results:

• No conversions to open surgery or conventional laparoscopy were required; supplementary instruments were needed in 27.8% of cases.
• No operative or postoperative mortalities were observed. Mean final incision lengths varied by location but were generally small (13.1-57.2 mm).
• Postoperative pain decreased during hospitalization, with 0-16.6% requiring analgesics post-discharge. Access-site complication rates were 7.5% (early) and 1.3% (hernia), with overall early and late general complication rates of 10.7% and 0.7%, respectively.

Conclusions:

• Single-incision laparoscopy (SIL) is a safe and viable laparoscopic technique for patients with abdominal diseases.
• Key advantages of SIL include improved cosmetic results and reduced abdominal trauma.
• Potential disadvantages involve patient selection, potentially longer operative times, and the need for improved operative field exposure in certain procedures.