A randomized pilot study on single-port versus conventional laparoscopic rectal surgery: effects on postoperative pain and the stress response to surgery.

BACKGROUND: Potential benefits of single-port laparoscopic surgery may include improved cosmetic results, less postoperative pain, surgical trauma and faster recovery. Results of randomized prospective studies with a focus on single-port rectal surgery have not yet been presented. The aim of the present study was to compare single-port and conventional laparoscopic surgery for rectal cancer in terms of short-term outcomes including postoperative pain and trauma-induced changes in certain bioactive substances. METHODS: Patients with non-metastasized rectal cancer were prospectively randomized to single-port (n = 20) or conventional laparoscopic rectal surgery (n = 20). Postoperative pain was assessed at rest, at coughing and during mobilization, with a numeric pain ranking score and was recorded at 6 h after the operation and subsequently every morning daily for 4 days. Levels of C-reactive protein (CRP), interleukin-6 (IL-6) and tissue inhibitor of metalloproteinases-1 (TIMP-1) were determined. Blood samples were collected preoperatively (baseline), and 6, 24, 48, 72 and 96 h after skin incision. RESULTS: Pain scores were significantly reduced in the single-port group on postoperative days 2, 3 and 4 during coughing and mobilization. In addition, the patients in the single-port group suffered significantly less pain at rest at 6 h after surgery and on postoperative days 1, 3 and 4. The levels of the three markers increased significantly after surgery. The increase was similar between groups for plasma IL-6 and TIMP-1 at all time points, while the CRP levels were significantly lower in the single-port group at 6 (p < 0.001) and 24 h (p < 0.05) after skin incision. Abdominal incisions lengths were significantly shorter in the single-port group (p = 0.001). There was no significant difference between groups in operating time and blood loss, morbidity or mortality rate. The short-term oncological outcome in the two groups was similar. CONCLUSIONS: Single-port rectal surgery may reduce postoperative pain. Although CRP levels were lower at some time points, results of the present randomized, pilot study suggest that the trauma-induced inflammatory response of single-port operations may be similar to the trauma-induced inflammatory response of conventional laparoscopic surgery.

Technique and short-term outcomes of single-port surgery for rectal cancer: a feasibility study of 25 patients.

BACKGROUND AND AIMS: Although conventional laparoscopic surgery is less traumatic than open surgery, it does cause tissue trauma and multiple scar formation. The size and number of ports determine the extent of the trauma. Single-port laparoscopic surgery is assumed to minimize and perhaps eliminate the potential adverse effects of conventional laparoscopy. The aim of this study was to examine short-term outcomes of single-port laparoscopic surgery for rectal cancer. MATERIAL AND METHODS: Prospectively collected data from 25 consecutive patients who underwent single-port laparoscopic surgery for rectal cancer between January 2010 and March 2012. Perioperative data, oncological resections, and short-term outcomes were assessed. RESULTS: Male:female ratio was 10:15. Of the 25 patients, 44% had previously undergone abdominal surgery. Median body mass index was 24 kg/m(2) (range: 19-32 kg/m(2)). In all, four patients (16%) had neoadjuvant therapy. Median operating time was 260 min (range: 136-397 min). An additional port was needed in two patients, and one case was converted to hand-assisted approach. Median postoperative stay was 7 days (range: 4-39 days), and three patients (12%) were readmitted. Median lymph node harvest was 13 (range: 3-33). The surgical margins were clear in all patients. Complications were seen in six patients. CONCLUSION: Single-port laparoscopic surgery for rectal cancer can be performed in selected patients with rectal cancer without compromising oncological safety and with acceptable morbidity and mortality rates.