Single-incision laparoscopic surgery (SILS) in complex colorectal surgery: a technique offering potential and not just cosmesis

Abstract

Aim: Single-incision (or port) laparoscopic surgery (SILS) has recently emerged as a method to improve morbidity and cosmetic benefit of conventional laparoscopic surgery. The literature contains two reports of SILS right hemicolectomy, and we report our experience of this technique.

Method: Seven consecutive, unselected patients underwent SILS retrocaecal appendicectomy, right hemicolectomy, extended right hemicolectomy, colectomy with ileorectal anastomosis, proctocolectomy, anterior resection and restorative proctocolectomy/ileoanal pouch using a single Triport (Olympus Keymed, Southend, UK), conventional instrumentation and nerve block analgesia. Three had undergone previous surgery, two had cancer and two were immunosuppressed.

Results: Umbilical, right- and left-iliac fossa SILS was feasible using conventional instruments. Operative time ranged between 23 and 195 min (median 48 min). Four patients tolerated normal diet within 6 h (12-16 h for the remainder). Only one patient required postoperative enteral morphine (10 mg × 4). Discharge occurred between 8 and 90 h (median 16 h) of surgery. A secondary haemorrhage from the ileorectal anastomosis was managed conservatively.

Conclusion: SILS colorectal resection is feasible and safe when performed by an experienced laparoscopic surgeon and theatre team. It may have advantages over conventional laparoscopic surgery in terms of reduced pain, lower cost, faster recovery and cosmesis.