• Colorectal cancer
• Laparoscopic surgery
• Reduced-Port surgery
• Robotic surgery
• Single-incision surgery

• Colon cancer
• Matched pair
• Minimally invasive surgery
• Rectal cancer
• Single access surgery

• Colectomy
• Humans
• Laparoscopy
• Length of Stay
• Neoplasm Recurrence, Local
• Operative Time
• Rectal Neoplasms/surgery
• Treatment Outcome

• Universitätsmedizin der Johannes Gutenberg-Universität Mainz (8974)

In patients with obstructing rectal cancers who require intestinal diversion before neoadjuvant therapy, minimizing diversion-related recovery and instituting early chemoradiation are critical to optimizing outcomes.

A novel, simple, safe, and inexpensive technique was developed for single-port laparoscopic diverting sigmoid loop colostomy in a low-resource environment.

Ten consecutive patients with locally advanced rectal cancer underwent single-port, diverting sigmoid loop colostomy using a novel application of the EK glove port. Operative time averaged 59.5 min (range 40–75 min). There were no conversions to multiport laparoscopy or open surgery. There were no intraoperative or early postoperative surgical complications. All patients started chemoradiation therapy within 1 week of diverting colostomy. No surgical reinterventions were required.

Single-port laparoscopic diverting sigmoid loop colostomy utilizing an EK glove port is a novel, technically simple, safe, and cost-effective procedure, especially applicable to patients with obstructing rectal cancer who receive care in a low resource environment.

• colostomy
• glove port
• laparoscopy
• locally advanced rectal cancer
• single-port laparoscopic

Although the anatomic difficulties of laparoscopic surgery for rectal cancer have been resolved by hybrid transanal total mesorectal excision (h-taTME), a completely incisionless surgical procedure has not yet been developed. This study was performed to explore the efficacy of pure taTME (p-taTME) without laparoscopic assistance as a completely non-invasive surgical procedure for rectal cancer.

We retrospectively evaluated all patients with rectal cancer who underwent p-taTME between December 2015 and April 2018. Relevant patient characteristics and clinical information including the surgical procedure, specimens, pathological characteristics, and patients’ post-operative state were analysed and the feasibility of p-taTME in patients with rectal cancer was assessed.

Fifty-five patients who had undergone p-taTME were included in this study. They comprised 32 (58.2%) men and 23 (41.8%) women with a mean age of 65.6 ± 10.6 years and mean body mass index of 23.4 ± 3.3 kg/m². The median surgical time was 180.0 (range, 130–360) min and estimated blood loss was 25.0 (range, 15–80) mL. The commonest post-operative complication was varying degrees of faecal incontinence (56.4%). However, such incontinence greatly improved after pelvic-floor-function-rehabilitation exercises and did not seriously affect the patients’ quality of life.

p-taTME is a relatively safe and incisionless procedure for patients with middle and low rectal cancer, especially in those with obesity or a narrow pelvis. However, further studies of the indications and long-term efficacy are needed to verify the suitability of this procedure.

• incisionless
• pure taTME
• rectal cancer
• surgery

• inflammatory bowel disease
• laparoscopy
• single port
• subtotal colectomy

• Colorectal cancer
• Endoscopic surgical skill qualification system
• Feasibility and Safety
• Learning curve
• Needlescopic surgery
• Novice surgeon

• Clinical Competence
• Endoscopy, Gastrointestinal/education
• Endoscopy, Gastrointestinal/instrumentation
• Endoscopy, Gastrointestinal/methods
• Equipment Design
• Feasibility Studies
• Female
• Humans
• Japan
• Learning Curve
• Male
• Middle Aged
• Minimally Invasive Surgical Procedures/instrumentation
• Minimally Invasive Surgical Procedures/methods
• Outcome Assessment, Health Care
• Postoperative Complications/prevention & control
• Proctocolectomy, Restorative/methods
• Rectal Neoplasms/surgery
• Sigmoid Neoplasms/surgery
• Surgeons/standards

• Consensus
• Laparoscopic surgery
• Laparoscopy
• Recommendation
• Single incision
• Statement

• Appendectomy/methods
• Cholecystectomy, Laparoscopic
• Colectomy/methods
• Endoscopy/education
• Endoscopy/instrumentation
• Endoscopy/methods
• Humans
• Learning Curve
• Operative Time
• Robotic Surgical Procedures/methods

The majority of patients with Crohn’s disease and up to 35 % of patients with ulcerative colitis will ultimately require surgery during the course of their disease. Over the past few years, surgical techniques and experience in minimal invasive surgery have evolved resulting in single-incision laparoscopic surgery. The aim of this approach is to diminish the surgical trauma by reducing the number of incision sites. This review discusses the benefits and disadvantages of single-port surgery in various procedures in patients with inflammatory bowel disease (IBD). Short-term postoperative results, functional outcome, and costs available in the literature will be discussed. Single-port surgery in IBD has several benefits when compared to multi-port laparoscopic surgery. By using fewer incisions, a potential reduction of postoperative pain with less morphine use can be accomplished. In addition, accelerated postoperative recovery can result in a shorter hospital stay. Furthermore, a superior cosmesis can be reached with placement of the port at the future ostomy site or at the umbilicus. Literature on single-port surgery in IBD consists mainly of case series and a few matched case series. These studies demonstrated that single-port surgery seems to be a safe and feasible approach for the surgical treatment of IBD patients.

• Colorectal disease
• Conventional laparoscopic surgery
• Efficacy
• Safety
• Single-incision laparoscopic surgery

There has been great enthusiasm for the technique of transanal total mesorectal excision. Coupled with this procedure, we performed single-incision laparoscopic surgery for left colon mobilization. This is a description of our initial experience with the combined approach.

Patients with distal or mid rectal cancer were included. The operation was performed by 2 teams: one team performed the single-incision mobilization of the left colon via the right lower quadrant ileostomy site, and the other team performed the total mesorectal excision with a transanal platform.

During the study period, 10 patients (5 men) with cancer of the rectum underwent the surgery. The mean age was 62.2 ± 11.1 years, and the mean body mass index was 23.4 ± 3.2 kg/m². The tumor's mean distance from the anal verge was 5.1 ± 2.5 cm. The median operating time was 247.5 minutes (range, 188–462 minutes). The mean estimated blood loss was 124 ± 126 mL (range, 10–188 mL). Conversion to multiport laparoscopy was needed in one case (10%). Postoperative pain, as reflected by the pain score, was minimal. The mean number of lymph nodes harvested was 15.6 ± 3.8. All specimens had clear distal and circumferential radial margins. The overall complication rate was 10%.

Our experience showed transanal total mesorectal excision with single-incision laparoscopy to be a feasible option for rectal cancer. Patients reported minimal postoperative pain. Further studies on the long-term outcome are warranted.

• Rectal cancer
• Single-incision laparoscopy
• TAMIS
• Transanal total mesorectal excision

• Notes
• flexible robot
• platform stability
• robotic assisted intervention
• triangulation

• Minilaparotomy
• Minimally invasive surgery
• Total laparoscopic left colon resection
• Total laparoscopic sigmoid colon resection
• Transanal extraction

To describe the procedure, efficacy, and utility of single-incision laparoscopic-assisted stoma creation (SILStoma) for transverse colostomy. Using single-incision laparoscopic surgery, we developed a standardized technique for SILStoma. Twelve consecutive patients underwent SILStoma for transverse colostomy at Osaka Medical Center for Cancer and Cardiovascular Diseases from April 2013 to March 2016. A single, intended stoma site was created with a 2.5-3.5 cm skin incision for primary access to the intra-abdominal space, and it functioned as the main port through which multi-trocars were placed. Clinical and operative factors and postoperative outcomes were evaluated. Patient demographics, including age, gender, body mass index, and surgical indications for intestinal diversion were evaluated. SILStoma was performed in nine cases without the requirement of additional ports. In the remaining three cases, 1-2 additional 5-mm ports were required for mobilization of the transverse colon and safe dissection of abdominal adhesions. No cases required conversion to open surgery. In all cases, SILStoma was completed at the initial stoma site marked preoperatively. No intraoperative or postoperative complications greater than Grade II (the Clavien-Dindo classification) were reported in the complication survey. Surgical site infection at stoma sites was observed in four cases; however, surgical interventions were not required and all infections were cured completely. In all cases, the resumption of bowel movements was observed between postoperative days 1 and 2. SILStoma for transverse loop colostomy represents a feasible surgical procedure that allows the creation of a stoma at the preoperatively marked site without any additional large skin incisions.

• Laparoscopic surgery
• Colostomy
• Stoma
• Postoperative complications
• Cosmetic outcomes

• Crohn’s
• Ileocecectomy
• SILS
• Single incision

• colorectal cancer
• reduced-port surgery
• skin incision

In this single-institution study, we aimed to compare the safety, feasibility, and outcomes of single-incision laparoscopic sigmoidectomy (SILSS) with multiport laparoscopic sigmoidectomy (MLS) for recurrent diverticulitis.

Between October 2011 and February 2013, 60 sigmoidectomies were performed by the same surgeon. Forty patients had a MLS and 20 patients had a SILSS. Outcomes were compared.

Patient characteristics were similar. There was no difference in morbidity, mortality or readmission rates. The mean operative time was longer in the SILSS group (P = .0012). In a larger proportion of patients from the SILSS group, 2 linear staplers were needed for transection at the rectum (P = .006). The total cost of disposable items was higher in the SILSS group (P < .0001). No additional ports were placed in the SILSS group. Return to bowel function or return to oral intake was faster in the SILSS group (P = .0446 and P = .0137, respectively). Maximum pain scores on postoperative days 1 and 2 were significantly less for the SILSS group (P = .0014 and P = .047, respectively). Hospital stay was borderline statistically shorter in the SILSS group (P = .0053). SILSS was also associated with better cosmesis (P < .0011).

SILSS is feasible and safe and is associated with earlier recovery of bowel function, a significant reduction in postoperative pain, and better cosmesis.

• Diverticulitis
• Single incision laparoscopic sigmoidectomy

• Laparoscopic surgery
• SILS
• ulcerative colitis

• Laparoscopic
• Oncological
• Right hemi-colectomy
• Single incision

• Rectal
• SILS
• cancer
• oncological
• outcomes
• single-incision laparoscopic

• colorectal surgery
• single-site
• single-incision
• laparoscopy
• multi-port laparoscopy

AIM: To compare the safety of single-port laparoscopic cholecystectomies with standard four-port cholecystectomies.

METHODS: Between January 2011 and December 2012 datas were gathered from 100 consecutive patients who received a single-port cholecystectomy. Patient baseline characteristics of all 100 single-port cholecystectomies were collected (body mass index, age, etc.) in a database. This group was compared with 100 age-matched patients who underwent a conventional laparoscopic cholecystectomy in the same period. Retrospectively, per- and postoperative data were added. The two groups were compared to each other using independent t-tests and χ²-tests, P values below 0.05 were considered significantly different.

RESULTS: No differences were found between both groups regarding baseline characteristics. Operating time was significantly shorter in the total single-port group (42 min vs 62 min, P < 0.05); in procedures performed by surgeons the same trend was seen (45 min vs 59 min, P < 0.05). Peroperative complications between both groups were equal (3 in the single-port group vs 5 in the multiport group; P = 0.42). Although not significant less postoperative complications were seen in the single-port group compared with the multiport group (3 vs 9; P = 0.07). No statistically significant differences were found between both groups with regard to length of hospital stay, readmissions and mortality.

CONCLUSION: Single-port laparoscopic cholecystectomy has the potential to be a safe technique with a low complication rate, short in-hospital stay and comparable operating time. Single-port cholecystectomy provides the patient an almost non-visible scar while preserving optimal quality of surgery. Further prospective studies are needed to prove the safety of the single-port technique.

• Single-port
• Minimal invasive
• Laparoscopy
• Safety
• Feasibility
• Cholecystectomy

• Obese
• Overweight
• Scarless
• Single-access surgery
• Single-site surgery
• Umbilical incision

• colon cancer
• colon resection
• robotic surgery
• single-incision laparoscopic surgery
• single-incision robotic surgery

Single-incision laparoscopic surgery (SILS) and natural orifice transluminal endoscopic surgery (NOTES) have rapidly gained pace worldwide, potentially replacing conventional laparoscopic surgery (CLS) as the preferred colorectal surgery technique. Currently available data mainly consist of retrospective series analyzed in four meta-analyses. Despite conflicting results and lack of an objective comparison, SILS appears to offer cosmetic advantages over CLS. However, due to conflicting results and marked heterogeneity, present data fail to show significant differences in terms of operative time, postoperative morbidity profiles, port-site complications rates, oncological appropriateness, duration of hospitalization or cost when comparing SILS with conventional laparoscopy for colorectal procedures. The application of “pure” NOTES in humans remains limited to case reports because of unresolved issues concerning the ideal access site, distant organ reach, spatial orientation and viscera closure. Alternatively, minilaparoscopy-assisted natural orifice surgery techniques are being developed. The transanal “down-to-up” total mesorectum excision has been derived for transanal endoscopic microsurgery (TEM) and represents the most encouraging NOTES-derived technique. Preliminary experiences demonstrate good oncological and functional short-term outcomes. Large-scale randomized controlled trials are now mandatory to confirm the long-term SILS results and validate transanal TEM for the application of NOTES in humans.

• Surgery
• Colon
• Rectum
• Cancer
• Laparoscopy
• Single-port
• Natural orifice transluminal endoscopic surgery

• Colonic Diseases/surgery
• Colonoscopy/adverse effects
• Colonoscopy/history
• Colonoscopy/mortality
• Colonoscopy/trends
• Colorectal Surgery/history
• Colorectal Surgery/trends
• History, 20th Century
• History, 21st Century
• Humans
• Laparoscopy/adverse effects
• Laparoscopy/history
• Laparoscopy/mortality
• Laparoscopy/trends
• Natural Orifice Endoscopic Surgery/adverse effects
• Natural Orifice Endoscopic Surgery/history
• Natural Orifice Endoscopic Surgery/mortality
• Natural Orifice Endoscopic Surgery/trends
• Postoperative Complications/etiology
• Rectal Diseases/surgery
• Risk Factors
• Treatment Outcome

• Aged
• Aged, 80 and over
• C-Reactive Protein/analysis
• Female
• Humans
• Interleukin-6/blood
• Laparoscopy/adverse effects
• Laparoscopy/methods
• Male
• Middle Aged
• Pain Measurement
• Pain, Postoperative/etiology
• Pilot Projects
• Prospective Studies
• Rectal Neoplasms/blood
• Rectal Neoplasms/surgery
• Stress, Physiological/physiology
• Tissue Inhibitor of Metalloproteinase-1/blood

• Adenomatous Polyposis Coli/surgery
• Adult
• Aged
• Aged, 80 and over
• Colectomy/methods
• Colonic Diseases/surgery
• Colonic Neoplasms/surgery
• Conversion to Open Surgery/statistics & numerical data
• Crohn Disease/surgery
• Diverticulitis/surgery
• Female
• Humans
• Laparoscopy/methods
• Male
• Middle Aged
• Operative Time
• Postoperative Complications/epidemiology
• Research Design
• Retrospective Studies
• Robotic Surgical Procedures/methods
• Treatment Outcome

• Crohn's disease
• Ileocolic resection
• Inflammatory bowel disease
• Minimal access surgery
• Single incision laparoscopy

A number of clinical trials have demonstrated that the laparoscopic approach for colorectal cancer resection provides the same oncologic results as open surgery along with all clinical benefits of minimally invasive surgery. During the last years, a great effort has been made to research for minimizing parietal trauma, yet for cosmetic reasons and in order to further reduce surgery-related pain and morbidity. New techniques, such as natural orifice transluminal endoscopic surgery (NOTES) and single-incision laparoscopy (SIL) have been developed in order to reach the goal of “scarless” surgery. Although NOTES may seem not fully suitable or safe for advanced procedures, such as colectomies, SIL is currently regarded as the next major advance in the progress of minimally invasive surgical approaches to colorectal disease that is more feasible in generalized use. The small incision through the umbilicus allows surgeons to use familiar standard laparoscopic instruments and thus, perform even complex procedures which require extraction of large surgical specimens or intestinal anastomosis. The cosmetic result from SIL is also better because the only incision is made through the umbilicus which can hide the wound effectively after operation. However, SIL raises a number of specific new challenges compared with the laparoscopic conventional approach. A reduced capacity for triangulation, the repeated conflicts between the shafts of the instruments and the difficulties to achieve a correct exposure of the operative field are the most claimed issues. The use therefore of this new approach for complex colorectal procedures might understandingly be viewed as difficult to implement, especially for oncologic cases.

• Colorectal cancer
• Laparoscopic surgery
• Single-incision surgery
• Single-access surgery
• Scarless surgery
• Technical challenges

• Clinical Trials as Topic
• Colectomy
• Colorectal Neoplasms/surgery
• Digestive System Surgical Procedures
• Humans
• Laparoscopy/methods
• Medical Oncology/methods
• Medical Oncology/trends
• Natural Orifice Endoscopic Surgery
• Neoplasms/surgery
• Treatment Outcome
• Umbilicus/surgery

• Low-grade appendiceal mucinous neoplasm
• Mucocele
• Reduced port surgery
• Single-incision laparoscopic surgery

• Minimally invasive surgery
• colon cancer
• rectal cancer
• single access surgery

AIM: To investigate whether transanal natural orifice specimen extraction (NOSE) is a better technique for rectal cancer resection.

METHODS: A prospectively designed database of a consecutive series of patients undergoing laparoscopic low anterior resection for rectal cancer with various tumor-node-metastasis classifications from March 2011 to February 2012 at the First Affiliated Hospital of Sun Yat-Sen University was analyzed. Patient selection for transanal specimen extraction and intracorporeal anastomosis was made on the basis of tumor size and distance of rectal lesions from the anal verge. Demographic data, operative parameters, and postoperative outcomes were assessed.

RESULTS: None of the patients was converted to laparotomy. Respectively, there were 16 cases in the low anastomosis and five in the ultralow anastomosis groups. Mean age of the patients was 45.4 years, and mean body mass index was 23.1 kg/m². Mean distance of the lower edge of the lesion from the anal verge was 8.3 cm. Mean operating time was 132 min, and mean intraoperative blood loss was 84 mL. According to the principle of rectal cancer surgery, we performed D2 lymph node dissection in 13 cases and D3 in eight. Mean lymph nodes harvest was 17.8, and the number of positive lymph nodes was 3.4. Median hospital stay was 6.7 d. No serious postoperative complication occurred except for one anastomotic leakage. All patients remained disease free. Mean Wexner score was 3.7 at 11 mo after the operation.

CONCLUSION: Transanal NOSE for total laparoscopic low/ultralow anterior resection is feasible, safe and oncologically sound. Further studies with long-term outcomes are needed to explore its potential advantages.

• Transanal specimen extraction
• Natural orifice specimen extraction
• Laparoscopic anterior resection
• Low/ultra-low anastomosis
• Total mesorectal excision

• Adenocarcinoma/secondary
• Adenocarcinoma/surgery
• Adult
• Anastomotic Leak/etiology
• Colectomy/adverse effects
• Colectomy/methods
• Colonoscopy
• Female
• Humans
• Laparoscopy/adverse effects
• Lymph Node Excision
• Lymphatic Metastasis
• Male
• Middle Aged
• Natural Orifice Endoscopic Surgery/adverse effects
• Rectal Neoplasms/pathology
• Rectal Neoplasms/surgery
• Rectum/pathology
• Rectum/surgery
• Time Factors
• Treatment Outcome
• Tumor Burden

• Single port
• laparoscopic colorectal surgery
• laparoscopic surgery