Department of Colorectal Surgery, Singapore General Hospital, Outram Road, Singapore 169608, Singapore.
Surg Endosc. 2013 Feb;27(2):471-7. doi: 10.1007/s00464-012-2460-8. Epub 2012 Jul 18.
Single-incision laparoscopic surgery (SILS) is a recent development of minimally invasive surgery for colorectal disease. The literature comparing it against conventional laparoscopic colectomy remains limited.
A retrospective case-cohort study compared the benefits and outcomes of SILS right hemicolectomy (SRH) with those of conventional laparoscopic right hemicolectomy (LRH). The medical records of consecutive patients from a prospectively collected database were reviewed. Demographic data, operative details, recovery parameters, and details of resected specimens were obtained and analyzed in an intention-to-treat manner.
From January 2006 to March 2011, 104 elective LRHs (72 %) and 40 elective SRHs (28 %) were performed. The demographics for these two groups were comparable in terms of gender, age, ethnicity, body mass index (BMI), comorbidities and American Society of Anesthesiology score. As the records showed, 62 % of the LRHs and 57 % of the SRHs were performed for malignancies (p = 0.536). Seven of the LRH cases (7 %) were converted to open procedure, whereas two of the SILS cases (5 %) were converted. Three SILS cases (7 %) were completed with additional laparoscopic ports. The two groups did not differ significantly in terms of wound length, mean operative time, lymph node clearance, or margins of resected specimen. The recovery parameters (pain score, hospital length of stay, and complications rate) also were equivalent between the two groups.
As a feasible and safe procedure with early postoperative outcomes equivalent to those for LRH, SRH is a suitable alternative. The possible advantages of SILS over conventional laparoscopic surgery may be validated only with randomized controlled trials in the future.
单切口腹腔镜手术（SILS）是微创结直肠疾病治疗的最新进展。将其与传统腹腔镜结肠切除术进行比较的文献仍然有限。
回顾性病例对照研究比较了 SILS 右半结肠切除术（SRH）与传统腹腔镜右半结肠切除术（LRH）的益处和结果。从一个前瞻性收集的数据库中回顾性地审查了连续患者的病历。以意向治疗的方式获得并分析了人口统计学数据、手术细节、恢复参数以及切除标本的详细信息。
从 2006 年 1 月至 2011 年 3 月，进行了 104 例选择性 LRH（72％）和 40 例选择性 SRH（28％）。这两组的性别、年龄、种族、体重指数（BMI）、合并症和美国麻醉医师协会评分在这些方面具有可比性。根据记录，LRH 中有 62％和 SRH 中有 57％是为恶性肿瘤进行的（p = 0.536）。LRH 中有 7 例（7％）转为开放性手术，而 SILS 中有 2 例（5％）转为开放性手术。SILS 中有 3 例（7％）需要额外的腹腔镜端口完成手术。两组在切口长度、平均手术时间、淋巴结清除率或切除标本切缘方面无显著差异。两组的恢复参数（疼痛评分、住院时间和并发症发生率）也相当。
作为一种可行且安全的手术，其术后早期结果与 LRH 相当，因此 SRH 是一种合适的替代方法。SILS 相对于传统腹腔镜手术的可能优势可能只有在未来的随机对照试验中才能得到验证。
