Single-Incision vs Straight Laparoscopic Segmental Colectomy: A Case-Controlled Study

TLDR

Single‑incision laparoscopic surgery is gaining traction in general surgery but has not yet been studied for laparoscopic colectomy. The study aimed to compare outcomes of single‑incision laparoscopic colectomy with laparoscopic‑assisted colectomy and to assess whether the device’s cost can be justified by improved clinical outcomes. Patients undergoing single‑incision colectomy were prospectively entered into a database and case‑matched to laparoscopic‑assisted colectomy patients on sex, age, disease, surgery, BMI, prior surgeries, and surgeon, with 29 single‑incision cases matched for the same indications. Single‑incision colectomy was feasible and safe with similar morbidity, length of stay, and scar length to laparoscopic‑assisted colectomy, but required longer operative time, occasional conversions, and an additional learning curve.

Abstract

Single-incision laparoscopic surgery is gaining momentum in general surgery but it is essentially unstudied for laparoscopic colectomy. The aim of our study was to compare outcomes for single-incision laparoscopic colectomy with laparoscopic-assisted colectomy.Patients undergoing laparoscopic colectomy were prospectively entered into an institutional review board-approved database. Those that underwent single-incision laparoscopic colectomy were case matched for sex, age, disease, surgery, body mass index, previous surgeries, and surgeon with patients undergoing LAC.Twenty-nine single-incision laparoscopic segmental colectomies were performed for polyps (4), adenocarcinoma (12), diverticulitis (6), and Crohn's disease (7) and were case matched to laparoscopic-assisted colectomy for the same indications. Mean body mass index was 28.8 ± 3 kg/m². Operative time was longer for single-incision laparoscopic colectomy (134.4 ± 40 vs 103.8 ± 54 min; P = .0002). Four single-incision laparoscopic colectomies were converted to LAC requiring either one extra port (2) or 2 extra ports (2), and there was one conversion to laparotomy. Extraction scar length (millimeters) was similar (38 ± 6.0 vs 45 ± 6.2; P = .746). Postoperative morbidity (5/29 vs 7/29; P = .284) and length of stay (day) (3.7 ± 1.1 vs 3.9 ± 1.1; P = .445) were similar between groups.Single-incision laparoscopic colectomy is feasible and safe but takes more time than laparoscopic-assisted colectomy. Although results approximate those for laparoscopic-assisted colectomy, an additional learning curve is involved, and extra incisions are sometimes required. Single-incision laparoscopic colectomy requires further prospective validation so that the cost of the device can be justified by an improved clinical outcome.