Safety and Efficacy of Single-Port Colectomy for Sigmoid Colon Cancer: A Phase II Clinical Trial

Chopstick technique versus cross technique in LESS hysterectomy (CCLEH study): a prospective randomized controlled trial

Background

The traditional cross technique can be used to complete most laparoendoscopic single-site surgery (LESS) procedures, but some relatively precise operations, such as vaginal stump suturing, are challenging. In practice, we have introduced a novel technique named the chopstick technique and applied it to more complex operations, such as cervical cancer operations, and found that it contributes to performing delicate surgery. The efficacy and safety of two different surgical techniques in LESS hysterectomy remain to be validated.

Methods

Patients who undergo total hysterectomy will be enrolled in this RCT. Stratified randomization will be performed according to uterine size (< 10 cm, 10–15cm, ≥ 15 cm). The participants will be divided into the chopstick technique group or cross technique group to undergo laparoendoscopic single-site total hysterectomy (LESS-TH), and then the perioperative and postoperative data, including the total operation time and other times, transfer rates, estimated blood loss, surgeon fatigue, intraoperative and postoperative complications (within 8 weeks after surgery), health-related quality of life (EQ-5D) scores, postoperative hospital stay, and hospitalization expenses, will be evaluated. The primary outcome is the operating time for total hysterectomy under LESS, and the other outcomes are secondary outcomes.

Discussion

It is expected that the efficacy of the two techniques in LESS, the chopstick technique vs. the cross technique, will be compared and accumulate safety data on the new techniques will be accumulated.

Trial registration

ChiCTR2000040843, registered on June 16,2020

Protocol version:

Version 2.0; Date: 2020.05.10

Supplementary Information

The online version contains supplementary material available at 10.1186/s13063-022-06650-w.

Learning curve for single-port robot-assisted rectal cancer surgery

Purpose

We analyzed the learning curve of single-port robotic (SPR)-assisted rectal cancer surgery.

Methods

Fifty-seven consecutive SPR-assisted rectal cancer surgery cases performed by the same surgeon were considered in surgical interventions for rectal cancer. Total operation time (OT), docking time (DT), and surgeon console time (SCT) measured during surgery were used to parametrize the learning curve. The parameters representing the learning curve were evaluated using the cumulative sum (CUSUM).

Results

The mean value of total OT was 241.8 ± 91.7 minutes, the mean value of DT was 20.6 ± 19.1 minutes, and the mean value of SCT was 135.9 ± 66.7 minutes. The learning curve was divided into phase 1 (initial 16 cases), phase 2 (second 16 cases), and phase 3 (subsequent 25 cases). The peak on the CUSUM graph occurred in the 21st case. The longest OT among phases was in phase 2. Complications were most frequent in phase 2. However, complications of Clavien-Dindo (CD) grade IIIb were most frequent in phase 3 with 2 patients. The most common complications were fluid collection and urinary retention (7 patients each). Complications of CD grade IIIb required one stomal revision due to stoma obstruction and one irrigation and loop ileostomy due to anastomosis leakage.

Conclusion

Improvement in surgical performance of SPR assisted rectal cancer operation was achieved after 21 cases. The three phases identified in the cumulative sum analysis showed a significant decrease in operative time after the middle stage of the learning curve without an increase in the complication rate.

Effect of sigmoidectomy in treating sigmoid colon cancer: A protocol of systematic review

BACKGROUND

This study will assess the effect of sigmoidectomy in treating sigmoid colon cancer (SCC).

METHODS

This study will search the following databases from inception to the present: MEDLINE, EMBASE, Cochrane Library, CINAHL, PsycINFO, Scopus, OpenGrey, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure. All electronic databases will be searched with no restrictions of language. Two researchers will independently handle all study selection, data extraction, and risk of bias, respectively. Any disparities between 2 researchers will be figured out by a third researcher through discussion. RevMan 5.3 software will be used for statistical analysis in this study.

RESULTS

This study will provide a high-quality synthesis of targeted outcomes to evaluate the efficacy and complications of sigmoidectomy in treating SCC.

CONCLUSION

The results of this study will provide evidence to judge whether sigmoidectomy can benefit patients with SCC.

STUDY REGISTRATION ON OSF

osf.io/dpxkg.

European association for endoscopic surgery (EAES) consensus statement on single-incision endoscopic surgery

BACKGROUND

Laparoscopic surgery changed the management of numerous surgical conditions. It was associated with many advantages over open surgery, such as decreased postoperative pain, faster recovery, shorter hospital stay and excellent cosmesis. Since two decades single-incision endoscopic surgery (SIES) was introduced to the surgical community. SIES could possibly result in even better postoperative outcomes than multi-port laparoscopic surgery, especially concerning cosmetic outcomes and pain. However, the single-incision surgical procedure is associated with quite some challenges.

METHODS

An expert panel of surgeons has been selected and invited to participate in the preparation of the material for a consensus meeting on the topic SIES, which was held during the EAES congress in Frankfurt, June 16, 2017. The material presented during the consensus meeting was based on evidence identified through a systematic search of literature according to a pre-specified protocol. Three main topics with respect to SIES have been identified by the panel: (1) General, (2) Organ specific, (3) New development. Within each of these topics, subcategories have been defined. Evidence was graded according to the Oxford 2011 Levels of Evidence. Recommendations were made according to the GRADE criteria.

RESULTS

In general, there is a lack of high level evidence and a lack of long-term follow-up in the field of single-incision endoscopic surgery. In selected patients, the single-incision approach seems to be safe and effective in terms of perioperative morbidity. Satisfaction with cosmesis has been established to be the main advantage of the single-incision approach. Less pain after single-incision approach compared to conventional laparoscopy seems to be considered an advantage, although it has not been consistently demonstrated across studies.

CONCLUSIONS

Considering the increased direct costs (devices, instruments and operating time) of the SIES procedure and the prolonged learning curve, wider acceptance of the procedure should be supported only after demonstration of clear benefits.

Six Cases of Simultaneous Reduced Port Laparoscopic Surgery for Synchronous Gastric and Colorectal Cancer

We report 6 cases of simultaneous resection of synchronous gastric and colorectal cancer using a multichannel port and an additional 5-mm port. This is the first report of simultaneous gastric and colorectal resection using a reduced port technique. A multichannel port was inserted into an umbilical incision, and another 5-mm port in the right flank region. We named this approach “dual port surgery.” This report includes a 76-year-old man who underwent total gastrectomy and left hemicolectomy, a 70-year-old woman who underwent distal gastrectomy and high anterior resection, a 75-year-old man who underwent distal gastrectomy and right hemicolectomy, a 72-year-old man who underwent total gastrectomy and sigmoidectomy, a 67-year-old man who underwent distal gastrectomy and high anterior resection, and a 57-year-old woman who underwent distal gastrectomy and right hemicolectomy. All operations were successful. All patients recovered quickly, and were discharged without any intra- or postoperative complications. On a median follow-up of 14.5 months, all patients remain well with no evidence of recurrent malignancy. This is the first report of simultaneous reduced port laparoscopic surgery for synchronous gastric and colorectal cancer. This procedure was performed safely and successfully.

Robot-Assisted Colectomy for Left-Sided Colon Cancer: Comparison of Reduced-Port and Conventional Multi-Port Robotic Surgery

PURPOSE

The robotic single-port access plus one conventional robotic port, a reduced-port robotic surgery (RPRS) for left-sided colon cancer, can enable lymphovascular dissection using the wristed instrumentation and safe rectal transection through an additional port maintaining the cosmetic advantage of the single-port surgery. The aim of this study is to compare the clinicopathological outcomes between reduced-port and conventional multi-port robotic colectomy for left-sided colon cancer.

METHODS

The study group included 23 patients who underwent an RPRS and 16 patients who underwent a multi-PRS (MPRS) for left-sided colon cancer between August 2013 and January 2016.

RESULTS

The operative time was significantly shorter in the RPRS group than in the MPRS group (mean time 258 ± 67 vs. 319 ± 66 minutes, P = .009). There were no apparent differences in tolerance of diet, postoperative pain score, length of hospital stay, the rate of postoperative complications, and the mean number of harvested lymph node, but the RPRS group had a significantly smaller total incision length (38 ± 12 mm vs. 83 ± 6 mm, P = .013).

CONCLUSIONS

This study shows the feasibility and safety of the RPRS, with clinicopathological outcomes that is comparable with that of the MPRS for left-sided colon cancer.

Reduced-port robotic anterior resection for left-sided colon cancer using the Da Vinci single-site(®) platform

BACKGROUND

Single-Site(®) port plus one conventional robotic port, a reduced-port robotic surgery (RPRS) for left-sided colorectal cancer, can enable lymphovascular dissection using the Endowrist(®) function; this allows safe rectal transection through an additional port and maintains the cosmetic advantage of single-incision laparoscopic surgery.

METHODS

Between August 2014 and December 2014, the study group included 11 patients who underwent a RPRS for left-sided colon cancer.

RESULTS

There was one (9.1%) case of descending colon cancer, six (54.5%) cases of sigmoid colon cancer, and four (36.4%) cases of rectosigmoid colon cancer. The mean total operation time and docking time were 289±77 and 17±7 min. The mean times to soft diet and possible length of stay were 5.6±0.8 and 7.4±0.7 days. The mean total number of lymph nodes harvested was 18.7±7.9. The mean proximal and distal resection margins were 7.8±4.7 and 4.7±2.4 cm.

CONCLUSIONS

Reduced-port robotic surgery for left-sided colon cancer using the Single-Site(®) system appears to be feasible and safe using the new robotic single-access platform. Copyright © 2015 John Wiley & Sons, Ltd.

Single-incision laparoscopic colorectal surgery: a report of 33 cases in Saudi Arabia

BACKGROUND

Single-incision laparoscopic surgery (SILS) has gained worldwide acceptance as a minimally invasive technique in colorectal procedures since its introduction in 2008. However, case series on its feasibility and safety in Saudi Arabia are lacking.

OBJECTIVE

Evaluate the operative results and clinical outcome of single-port laparoscopic procedures in colorectal surgeries.

DESIGN

Retrospective.

SETTING

This study was conducted at King Khalid university Hospital, Riyadh, Saudi Arabia.

PATIENTS AND METHODS

Demographic and clinical data, including pathology, and intraoperative and postoperative outcomes, were prospectively collected in patients undergoing SILS. This study was conducted during the period from January 2010 and October 2014.

MAIN OUTCOME MEASURES

Demographic and postoperative outcomes in patients undergoing SILS colectomies.

RESULTS

Thirty-three (33) patients underwent SILS. The mean (SD) age was 51 years (18.2 years), and the average body mass index was 26.6 (6.9) kg/m2. Patients were primarily diagnosed with cancer (n=20/33, 61%), inflammatory bowel disease (n=12/33, 36%) and diverticulitis (n=1/33, 3%). Procedures included anterior resection (n=9/33, 27%), ileocecal resection (n=8/33 24%), hemicolectomy (n=7/33, 21%), extended right hemicolectomy (n=5/33, 15%) and total colectomy (n=4/33, 12%). The mean SD operative time was 212 minutes (76.4 minutes). The mean SD size of the extraction incision was 4.2 (1.7) cm. Six percent of the cases were converted to open (n=2/33), and 9% required placement of an extra port (n=3/33). Four (12%) patients had intraoperative complications, and 30% experienced postoperative complications. The average length of hospital stay was 6.4 (4.3) days.

COCNLUSIONS

SILS is technically feasible and safe for patients undergoing colorectal surgery with no unusual complications. However, comparative studies are necessary to validate the potential benefits of SILS over conventional colorectal laparoscopic surgery.

LIMITATIONS

The study lacked a comparison to conventional open procedures. Additionally, some evaluation criteria were not considered, including cosmesis, pain control, patient satisfaction and cost effectiveness.

Robot-assisted single-incision total colectomy: a case report

BACKGROUND

Literature reports shows that robots provide an opportunity for meeting technical challenges associated with Laparo-endoscopic Single Site Surgery (LESS). Following previous success with robot-assisted single-incision right hemicolectomy, this paper reports experience with robot-assisted single-incision total colectomy.

METHODS

Through a single incision around the umbilicus, three robotic ports and a laparoscopic port were placed through the GelPOINT. With one intraoperative redocking of the robot, it was possible to access both right and left sides of the colon. The entire colon was externalized through the GelPOINT and the umbilical incision closed in layers.

RESULTS

The entire procedure took 227 minutes. There was minimal blood loss. The patient was discharged on post-operative day four with no complications. No wound site complications were observed in clinic one week after discharge.

CONCLUSIONS

Robot-assisted single-incision total colectomy is a feasible procedure associated with little increase in operative time.