Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Surg Proced. Mar 28, 2015; 5(1): 58-64
Published online Mar 28, 2015. doi: 10.5412/wjsp.v5.i1.58
New approaches in laparoscopic surgery for colorectal diseases: The totally laparoscopic and single-incision approaches
Hiroki Akamatsu, Masahiro Tanemura, Kentaro Kishi, Mitsuyoshi Tei, Toru Masuzawa, Masaki Wakasugi
Hiroki Akamatsu, Masahiro Tanemura, Kentaro Kishi, Mitsuyoshi Tei, Toru Masuzawa, Masaki Wakasugi, Department of Surgery, Osaka Police Hospital, Osaka 543-0035, Japan
Author contributions: All authors contributed to this work.
Conflict-of-interest: No conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Hiroki Akamatsu, MD, PhD, Department of Surgery, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoji-ku, Osaka 543-0035, Japan.
Telephone: +81-6-67716051 Fax: +81-6-67752838
Received: September 25, 2014
Peer-review started: September 25, 2014
First decision: November 27, 2014
Revised: December 27, 2014
Accepted: January 9, 2015
Article in press: January 12, 2015
Published online: March 28, 2015

More than 20 years have passed since the first report of laparoscopic colectomy in 1991. Thereafter, laparoscopic surgery for the management of colorectal diseases has been widely accepted as a prevailing option because of improved cosmetic outcomes, less postoperative pain, and shorter hospital stay in comparison with open surgery. To further the principle of minimally invasive surgery, two new approaches have been developed in this rapidly evolving field. The first is the totally laparoscopic approach. Currently most of standard techniques inevitably involve an abdominal incision for retrieval of the specimen and preparation for anastomosis, which might compromise the benefits of laparoscopic surgery. The totally laparoscopic approach dispenses with this incision by combining completely intraperitoneal anastomosis with retrieval of the specimen via a natural orifice, such as the anus or the vagina. Our new and reliable technique for intraperitoneal anastomosis is also described in detail in this article. The second is the single-incision approach. While three to six ports are needed in standard laparoscopic surgery, the single-incision approach uses the umbilicus as the sole access to the abdominal cavity. All of the laparoscopic procedures are performed entirely through the umbilicus, in which the surgical scar eventually becomes hidden, achieving virtually scarless surgery. This article reviews the current status of these two approaches and discusses the future of minimally invasive surgery for colorectal diseases.

Keywords: Totally laparoscopic surgery, Minimally invasive surgery, Single-incision laparoscopic surgery, Natural orifice transluminal endoscopic surgery, Natural orifice specimen extraction

Core tip: We reviewed the current status of two new approaches in laparoscopic surgery for colorectal diseases: the totally laparoscopic and single-incision approaches, and showed our own data concerning these two approaches. We also discussed the future of minimally invasive surgery.