الفهرس | Only 14 pages are availabe for public view |
Abstract Summary Open surgery for colorectal disease has progressed significantly over the past century from humble beginnings to form the mainstay of treatment for colorectal cancer and a number of benign conditions. Following the introduction of laparoscopic abdominal surgery, the next stage in the evolution of the specialty began in the 1990s with the first laparoscopic colonic resection. Following some early concerns regarding its safety and oncological efficacy during the latter part of that decade, laparoscopic colorectal surgery rapidly came into mainstream use in the early part of the current century with evidence supporting its use being made available from large scale randomised controlled trials. Among the various surgical modalities for colorectal diseases, the laparoscopic colorectal surgery is considered a widely accepted procedure and its popularity is increasing in the colorectal surgery field. Its short and long term outcomes have shown to be well tolerated with satisfactory body weight control. The numerous advantages of laparoscopic procedures compared to the open counterparts have inspired an interest in even more minimally invasive surgical approaches. This interest facilitated the birth of needlescopic instruments, natural orifice transluminal endoscopic surgery , and singleaccess laparoscopy. Single-access laparoscopy involves the introduction of special multichannel access devices that allow laparoscopic surgery to be performed through one incision, preferably the umbilicus. The potential advantages of this approach are related to limiting the port incisions to one site, in addition to the advantages of traditional minimally invasive surgery. In the present study we conducted an evaluation of laparoscopic single port colorectal surgery for patients with colorectal disease regarding its feasibility, safety, technical challenges, advantages and assessment of its effects on weight loss and complications. As regards the technique, it was challenging to perform the whole procedure from a single incision. However we managed to introduce a protocol to perform the operation, achieve a full harmony between the operating surgeons and the used instruments. In this way, the surgical obstacles were minimized and our experience was gradually increasing to achieve the best results. Our mean operative time for the right colon was 3.42 hrs (range 2.5-4.5), for the left colon was 4.5 hrs (range 3.5- 5.5), for upper rectum 5.15 hrs (range 4-6), for the transverse colon was 3.17 hrs (range 3-3.15) and for total colectomy was 5.13 hrs (range 5-5.5) which was longer in the first number of patients and then reduced with gaining experience in the procedures. 10 patients (33.3%) were converted to conventional laparoscopic procedure due to bleeding in 5 cases, bowel injury in 3 cases and technical difficulties in 2 cases. Another 3 cases were converted to open surgery due to large malignant masses in 2 cases and massive bleeding in 1 case. The mean hospital stay was 7.4 days. The substantial reduction in abdominal wall trauma through the introduction of single port through the umbilicus was translated into less postoperative pain, more rapid recovery, less wound complications and of course better cosmetic outcomes. Early postoperative complications included 7 patients (20%) who were 2 cases complicated by leakage, the first case underwent re-exploration with repair of the leaking site and covering ileostomy, and the second one was controlled by conservative treatment, there was 1 case with wound infection managed by oral antibiotics and resolved, 1 cas with DVT which was controlled by low molecular weight heparin then oral anticoagulants and 3 cases with chest infection and was controlled by intravenous antibiotics and resolved. There were 2 patients who developed incisional hernia and they were managed by repair with mesh. Otherwise there were no more serious complications. The mortality rate was 0%. |