Journal of Minimally Invasive Surgery 2018; 21(1): 3-4  https://doi.org/10.7602/jmis.2018.21.1.3
Re-operative Single Incision Laparoscopic Surgery: A Feasible Surgical Option in Highly Selected Clinical Setting
Duck-Woo Kim
Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
Correspondence to: Duck-Woo Kim, Department of Surgery, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam 13620, Korea, Tel: +82-31-787-7101, Fax: +82-31-787-4055, E-mail: kdw@snubh.org, ORCID: http://orcid.org/0000-0001-9218-4676
Published online: March 15, 2018.
© Journal of Minimally Invasive Surgery. All rights reserved.

cc This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Over the past decade, surgeons tried to find a less invasive surgical approach method compared to multi-port laparoscopic surgery to improve short-term outcomes. These efforts lead to finding newer methods, such as natural orifice transluminal surgery or single-incision laparoscopic surgery (SILS). To date, there have been many favorable studies reporting the potential benefits of SILS over multi-port laparoscopic surgery in terms of less postoperative pain, reduction of morbidity, better cosmetic outcome, and better overall patient satisfaction.13

In spite of previous studies, the true benefits of SILS over multi-port laparoscopic approach in major colorectal surgery remain unclear. Moreover, the obvious complexity in manipulating various surgical instruments through a single port requires an adequate learning period. The present study reported the short-term results of re-operative SILS (R-SILS) based on a large patient cohort that underwent primary SILS for colorectal diseases. The authors reported comparative outcomes of R-SILS to multi-port laparoscopic surgery in terms of postoperative complications and length of hospital stay. They also showed R-SILS could be applied to both elective and emergent operations.

As the authors comment as a limitation of this study, all R-SILS were performed by only one fully-experienced surgeon. R-SILS in patients with postoperative complications will definitely require a more proficient set of surgical skills. Currently available literatures on SILS in colorectal surgery have certain limitations that need to be clarified.1 First, most of the studies were retrospective in nature and based on highly selective patients. 4 The studies were also very heterogeneous in the range of surgical procedures, equipment/devices used, and patients’ characteristics.5 Most importantly, SILS is usually performed by highly motivated groups with good SILS skills. So, these favorable results may not be reproducible by the other surgeons. A recent meta-analysis based on 32 studies including 3,863 patients excellently summarized the current status of SILS. In this review, colorectal SILS had comparative outcomes to multi-port laparoscopic surgery in terms of operative time, conversion rate, postoperative complications and mortality. The short-term oncological results of SILS for colorectal cancer were satisfactory including lymph node harvest rates and resection margins. Nevertheless, there are currently no available long-term results comparing the survival rates and recurrence rates.

SILS and R-SILS performed by proficient SILS surgeons may have comparative results to multi-port laparoscopic colorectal surgery. In this setting, SILS could be a feasible and safe surgical option in re-operative colorectal surgery with good surgical outcomes for selected patients. However, to date, the evidences are far too insufficient to recommend SILS as a widespread approach replacing multi-port laparoscopic surgery, even more so in re-operative settings. Results from presently conducted large RCTs are needed to establish the indications and efficacy for SILS in colorectal surgery.

References
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