الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 142 |  |  |
| | | from | 142 | | |
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%.