Laparoscopic colorectal surgery is well established as an alternative to conventional open resection, leading to earlier postoperative recovery, decreased postoperative pain and a shorter hospital stay. Conventionally, invasive laparoscopic colorectal surgery is performed as a multiport surgery, using several trocar sites and a separate incision for specimen extraction; but this has the disadvantage of each incision being a potential site of bleeding, hematoma, infection and incisional hernia, explain the authors of the present pan-European study. Single-port colorectal surgery would offer significant advantages in this respect, but the data on this approach is still insufficient. The multi-institutional European study group (ECSPECT) was established to assess the general feasibility and safety of single-port colorectal surgery, and to provide guidance for patient selection. The study included 1,769 patients (937 with benign conditions, 832 with malignant conditions).
4.2 % of patients required conversion to open surgery; conversions were more than twice as frequent in pelvic procedures involving the rectum than in abdominal procedures (8.1 versus 3.2 %; odds ratio 2.69, P < 0.001). Postoperative complications occurred in 12.7 % of patients, and independent predictors of complications included male sex (P < 0.001), higher ASA grade (P = 0.006) and rectal procedures (P = 0.002). The overall 30-day mortality rate was 0.5 %.
This study shows the broad feasibility and safety profile of the single-port colorectal surgery technique and therefore endorses its general applicability, conclude the authors. Patient selection should be guided by the sex of the patient and his or her risks for conversion and complication.