Single-port access laparoscopic surgery for rectal cancer: initial experience with 10 cases.

Bulut, Orhan; Nielsen, Claus B; Jespersen, Niels

BACKGROUND Single-port access laparoscopic surgery is emerging as a method to improve the morbidity and cosmetic benefits of conventional laparoscopic surgery and minimize the surgical trauma. However, the feasibility of this procedure in rectal surgery has not yet been determined. OBJECTIVE This study aimed to evaluate our initial experience using single-port access in laparoscopic rectal surgery. DESIGN This investigation was designed as a prospective clinical study. SETTINGS The study took place in a university hospital. PATIENTS Ten patients with nonmetastatic rectal cancer underwent rectal resections. MAIN OUTCOME MEASURES The main outcome measures are perioperative data including intraoperative and postoperative complications, pathological outcome, length of stay, and short-term follow-up. RESULTS The median age of the patients was 67 (range, 49-83) and the median body mass index was 23.5 kg/m (range, 20-25 kg/m). Six patients had previously had abdominal surgery. The operations were 6 low anterior resections (4 receiving diverting ileostomy), 2 anterior resections, 1 Hartmann procedure, and 1 abdominoperineal resection. The median operative time was 229 minutes (range, 185-318), and blood loss ranged from 0 to 100 mL. In 2 cases, it was necessary to add an extra 5-mm port to deal with intraoperative complications. The median hospital stay was 7 days (range, 4-14). There were no anastomotic leaks and no mortality. All of the resection margins were clear, and the circumferential resection margin was a median of 11 mm (range, 2.5-25). The median number of lymph nodes examined was 14 (range, 3-20). LIMITATIONS This study's limitations include the lack of registration of postoperative pain, immunological parameters, and long-term clinical and oncological outcome. The small sample size makes it difficult to ascertain complication and conversion rates. CONCLUSIONS Single-port access laparoscopic surgery for rectal cancer can be performed safely in slim patients with a small tumor. This technique can be an alternative option for selected patients in the hands of skilled laparoscopic surgeons. Prospective comparative studies are needed to determine the role for this technique approach in the future.