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Feasibility of Colonic and Gastric Standard Laparoscopic Procedures With a Single Skin Incision Approach

Feasibility of Colonic and Gastric Standard Laparoscopic Procedures With a Single Skin Incision... We read with great interest the article by Leroy et al1 about their innovative single-access laparoscopic sigmoidectomy for diverticulitis. The rationale for this minimally invasive procedure is the improved cosmetic results; the potential decrease in morbidity related to visceral and vascular injuries during trocar placement; and the lower risk of postoperative wound infection, hernia formation, and pain. By using technical innovations like umbilical, multichannel, single-port, magnetic anchoring; roticulated graspers; and intraluminal assistance for traction, they performed a sigmoidectomy for diverticulitis via a 2-cm single skin incision. However, because of the difficulty in performing full mesenteric dissections, they consider this procedure unsuitable for oncologic resections. We share the authors' enthusiasm for this innovative technique, but we believe that its promising benefits can also be achieved with a single 4-cm periumbilical skin incision and 3 adjacent trocars inserted through separated fascial sites; conventional instruments; and traction stitches. Using this technique, in the last 6 months we were able to reproduce the standard laparoscopic procedures in performing 12 (8 left and 4 right) colonic resections for cancer, 4 distal gastrectomies for benign (n = 2) and malignant (2 D1-resections) diseases, and 1 left hepatic sectionectomy for a recurrent giant cyst. Mortality and morbidity were nil, but 1 left colectomy was converted for bleeding. In conclusion, we think that the single-incision laparoscopic approach is also safe and feasible for gastric and colonic cancer, even if its clinical advantages over standard laparoscopy should be demonstrated by future studies. Correspondence: Dr Mingoli, Dipartimento Emergenza Accettazione, Unità Operativa Dipartimentale Chirurgia del Politrauma, Sapienza University, Policlinico Umberto I, Viale del Policlinico 155, 00161 Rome, Italy (andrea.mingoli@uniroma1.it). Author Contributions:Study concept and design: Huscher, Mingoli, Sgarzini, Brachini, and Binda. Acquisition of data: Huscher, Mingoli, and Sgarzini. Drafting of the manuscript: Huscher, Mingoli, Sgarzini, Brachini, and Binda. Critical revision of the manuscript for important intellectual content: Huscher. Administrative, technical, and material support: Brachini and Binda. Study supervision: Huscher, Mingoli, and Sgarzini. Financial Disclosure: None reported. References 1. Leroy JCahill RAAsakuma MDallemagne BMarescaux J Single-access laparoscopic sigmoidectomy as definitive surgical management of prior diverticulitis in a human patient. Arch Surg 2009;144 (2) 173- 179PubMedGoogle ScholarCrossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Feasibility of Colonic and Gastric Standard Laparoscopic Procedures With a Single Skin Incision Approach

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Publisher
American Medical Association
Copyright
Copyright © 2009 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.2009.168
Publisher site
See Article on Publisher Site

Abstract

We read with great interest the article by Leroy et al1 about their innovative single-access laparoscopic sigmoidectomy for diverticulitis. The rationale for this minimally invasive procedure is the improved cosmetic results; the potential decrease in morbidity related to visceral and vascular injuries during trocar placement; and the lower risk of postoperative wound infection, hernia formation, and pain. By using technical innovations like umbilical, multichannel, single-port, magnetic anchoring; roticulated graspers; and intraluminal assistance for traction, they performed a sigmoidectomy for diverticulitis via a 2-cm single skin incision. However, because of the difficulty in performing full mesenteric dissections, they consider this procedure unsuitable for oncologic resections. We share the authors' enthusiasm for this innovative technique, but we believe that its promising benefits can also be achieved with a single 4-cm periumbilical skin incision and 3 adjacent trocars inserted through separated fascial sites; conventional instruments; and traction stitches. Using this technique, in the last 6 months we were able to reproduce the standard laparoscopic procedures in performing 12 (8 left and 4 right) colonic resections for cancer, 4 distal gastrectomies for benign (n = 2) and malignant (2 D1-resections) diseases, and 1 left hepatic sectionectomy for a recurrent giant cyst. Mortality and morbidity were nil, but 1 left colectomy was converted for bleeding. In conclusion, we think that the single-incision laparoscopic approach is also safe and feasible for gastric and colonic cancer, even if its clinical advantages over standard laparoscopy should be demonstrated by future studies. Correspondence: Dr Mingoli, Dipartimento Emergenza Accettazione, Unità Operativa Dipartimentale Chirurgia del Politrauma, Sapienza University, Policlinico Umberto I, Viale del Policlinico 155, 00161 Rome, Italy (andrea.mingoli@uniroma1.it). Author Contributions:Study concept and design: Huscher, Mingoli, Sgarzini, Brachini, and Binda. Acquisition of data: Huscher, Mingoli, and Sgarzini. Drafting of the manuscript: Huscher, Mingoli, Sgarzini, Brachini, and Binda. Critical revision of the manuscript for important intellectual content: Huscher. Administrative, technical, and material support: Brachini and Binda. Study supervision: Huscher, Mingoli, and Sgarzini. Financial Disclosure: None reported. References 1. Leroy JCahill RAAsakuma MDallemagne BMarescaux J Single-access laparoscopic sigmoidectomy as definitive surgical management of prior diverticulitis in a human patient. Arch Surg 2009;144 (2) 173- 179PubMedGoogle ScholarCrossref

Journal

Archives of SurgeryAmerican Medical Association

Published: Oct 19, 2009

Keywords: laparoscopy,colon,skin

References