Division of Colorectal Surgery, Department of Surgery, Center of Minimally Invasive Surgery, China Medical University Hospital, China Medical University, No. 2, Yu-Der Road, Taichung, 404, Taiwan.
Surg Endosc. 2011 Jun;25(6):1887-92. doi: 10.1007/s00464-010-1481-4. Epub 2011 Feb 27.
Since the introduction of laparoscopic colectomy, improved short-term surgical results have been noted in the literature. Therefore, efforts have shifted to reducing the invasiveness of laparoscopic surgery, resulting in the invention of single-incision laparoscopic surgery (SILS). Due to its comparable capabilities and feasibility, the implementation of SILS has rapidly grown in different fields. However, few studies discuss its true benefit compared with conventional laparoscopy. This study is the first to use SILS colectomy as an approach for malignant colon cancer. The goal of this cohort series is to compare the short-term surgical outcomes between SILS and conventional right hemicolectomy.
This was a case-control study comparing SILS right hemicolectomy patients to traditional laparoscopic right hemicolectomy. The inclusion criteria were only ascending colon cecal lesions. Cases of obstruction or perforation that required emergent operation or previous abdominal surgery were excluded. These patients were specifically matched in regard to patient's age, gender, perioperative condition, surgical indication, and tumor size. No consideration or analysis of operative parameters and outcomes was made until this group was definitively selected as the best comparison cohort based on preoperative variables only.
A total of 18 patients were included for SILS and the other 21 patients were completed by conventional laparoscopic right hemicolectomy. The SILS and traditional laparoscopic groups were similar in regard to age, gender, body mass index, and perioperation outcomes. Initial oncologic results were no different, including equal length of distal cut margin, numbers of harvested lymph nodes, and TMN stage. Three patients in the SILS colectomy group were converted (16.6%), and there were no conversions in the traditional laparoscopic colectomy group.
Our preliminary experience with SILS right hemicolectomy demonstrated the safety of the procedure and its feasibility in malignant colon cancer. Although SILS right hemicolectomy may provide a subjective cosmetic advantage, there was no benefit in the short-term surgical outcomes. SILS is very situational, requires more effort from the surgeon, and may not offer more patient comfort. More experience with SILS and prospective trials are needed to validate it as a more favorable alternative to conventional laparoscopic colectomy.
自从腹腔镜结肠切除术问世以来，文献中已经注意到短期手术结果得到了改善。因此，人们努力减轻腹腔镜手术的侵袭性，从而发明了单切口腹腔镜手术（SILS）。由于其具有相当的能力和可行性，SILS 的实施在不同领域迅速发展。然而，很少有研究讨论其与传统腹腔镜手术相比的真正益处。本研究首次将 SILS 结肠切除术用于恶性结肠癌。本队列研究的目的是比较 SILS 和传统右半结肠切除术的短期手术结果。
这是一项病例对照研究，比较 SILS 右半结肠切除术患者与传统腹腔镜右半结肠切除术患者。纳入标准仅为升结肠盲肠病变。排除梗阻或穿孔需要急诊手术或既往腹部手术的病例。这些患者在患者年龄、性别、围手术期情况、手术指征和肿瘤大小方面进行了专门匹配。直到根据术前变量明确选择该组作为最佳比较队列后，才考虑或分析手术参数和结果。
共有 18 例患者接受 SILS，另外 21 例患者接受传统腹腔镜右半结肠切除术。SILS 和传统腹腔镜组在年龄、性别、体重指数和围手术期结果方面相似。初始肿瘤学结果无差异，包括远端切缘长度、淋巴结检出数和 TMN 分期相同。SILS 结肠切除术组有 3 例（16.6%）中转开腹，传统腹腔镜结肠切除术组无中转开腹。
我们对 SILS 右半结肠切除术的初步经验表明该手术是安全的，适用于恶性结肠癌。尽管 SILS 右半结肠切除术可能提供主观的美容优势，但在短期手术结果方面没有优势。SILS 非常特殊，需要外科医生付出更多努力，并且可能不会为患者带来更多舒适感。需要更多的 SILS 经验和前瞻性试验来验证其作为传统腹腔镜结肠切除术更有利的替代方法。
