Review of 500 single incision laparoscopic colorectal surgery cases - Lessons learned

Table 1 Diagnosis and procedure for 1^st 500 single incision laparoscopic surgery cases n (%)

Diagnosis
Colon cancer	156 (31.2)
Diverticulitis	133 (26.6)
Polyp	114 (22.8)
IBD	47 (9.4)
Constipation	19 (3.8)
Rectal cancer	18 (3.6)
Incontinence/prolapse	4 (0.8)
Endometriosis	2 (0.4)
Other	7 (1.4)
Procedure
Right hemicolectomy/ileocolic resection	197 (39.4)
Anterior rectosigmoidectomy	134 (26.8)
Low anterior resection	69 (13.8)
Total/subtotal abdominal colectomy	47 (9.4)
Sigmoid/left Hemicolectomy	31 (6.2)
Transverse colectomy	9 (1.8)
Ileal pouch anal anastomosis	9 (1.8)
Small bowel resection	4 (0.8)

IBD: Inflammatory bowel disease.

Table 2 Outcomes for the 1^st 500 single incision laparoscopic surgery cases n (%)

Variable	Value
Age (yr), mean ± SD	57.61 ± 15.54
BMI (kg/m2), mean ± SD	26.47 ± 4.70
ASA score, median (range)	2 (2-4)
Previous abdominal operation	288 (57.6)
Operative time (min), mean ± SD	149.89 ± 61.98
Blood loss (mL), mean ± SD	64.13 ± 49.78
Intraoperative complications	11 (2.2)
Stoma created	66 (13.2)
Intraoperative conversion	34 (6.8)
Postoperative ICU stay	8 (1.6)
Postoperative complications	49 (9.8)
Clavien class 1	12
Clavien class 2	16
Clavien class 3	18
Clavien class 4	2
Clavien class 5	1
Length of stay (d), mean ± SD	3.91 ± 3.06
Readmission	22 (4.4)
Unplanned re-operation	10 (2.0)
Mortality	1 (< 1.0)

Table 3 Single incision laparoscopic surgery vs single incision laparoscopic surgery + 1 outcome data n (%)

Value	SILS (n = 44)	SILS + 1 (n = 88)	P value
Diagnosis			0.77
Diverticulitis	40 (90.9)	77 (87.5)
Rectal cancer	4 (9.1)	11 (12.5)
Gender
Female	22 (50)	44 (50)	1.00
Male	22 (50)	44 (50)
Age (yr)	56.14 (12.83)	57.16 (10.98)	0.63
Body mass index (kg/m2), mean ± SD	26.57 ± 4.36	27.63 ± 4.50	0.42
ASA class, median	2 (range 2-3)	2 (range 2-4)	0.86
Procedure			1.00
Anterior rectosigmoidectomy	38 (86.4)	76 (86.4)
Low anterior resection	6 (13.6)	12 (13.6)
Operative time (min), mean ± SD	178.0 ± 70.0	166.6 ± 48.4	0.051
Conversion rate	5 (11.4)	1 (1.1)	0.021
Intraoperative complications	1 (2.3)	1 (1.1)	1.00
Length of stay (d), mean ± SD	3.45 ± 1.00	3.56 ± 1.49	0.45
Postoperative complications	2 (4.5)	-	0.11
Readmission (30 d)	1 (2.3)	-	0.33

¹Statistically significant values at an alpha level of 0.05.

Table 4 Single incision laparoscopic surgery for obese vs non-obese patients n (%)

Parameter	Non-obese (n = 80)	Obese (n = 80)	P value
Age (yr), mean ± SD	57.2 ± 12.8	57.0 ± 12.7	0.926
Gender			1.000
Male	41 (51.2)	41 (51.2)
Female	39 (48.8)	39 (48.8)
Body mass index (kg/m2)	22.8 (2.3)	33.4 (3.2)	< 0.001
ASA score, median (range)	II (I-III)	III (I-IV)	0.035*
Diagnosis			1.000
Diverticulitis	29 (36.3)	29 (36.3)
Colon cancer	23 (28.7)	23 (28.7)
Polyp	17 (21.3)	17 (21.3)
Inflammatory bowel disease	7 (8.7)	7 (8.7)
Constipation	4 (5.0)	4 (5.0)
Procedure			1.000
Anterior rectosigmoidectomy	39 (48.8)	39 (48.8)
Right hemicolectomy	29 (36.3)	29 (36.3)
Total abdominal colectomy	7 (8.8)	7 (8.8)
Left colectomy	3 (3.8)	3 (3.8)
Transverse colectomy	2 (2.5)	2 (2.5)
Operative time (min), mean ± SD	144.4 ± 47.2	176.9 ± 64.0	< 0.001
Blood loss (mL), mean ± SD	51.6 ± 38.0	89.0 ± 139.5	< 0.001
Intraoperative complications	2 (2.5)	1 (1.3)	0.987
Intraoperative conversion	2 (2.5)	4 (5.0)	0.682
Final incision length (cm), mean ± SD	3.5 ± 1.1	4.0 ± 1.5	0.080
Length of stay (d), mean ± SD	3.7 ± 2.1	4.1 ± 2.2	0.332
Postoperative complications	6 (7.5)	10 (12.5)	0.430
Reoperation	2 (2.5)	1 (1.3)	0.987
Readmissions	3 (3.8)	3 (3.8)	1.000