Clinical Study Of Single Plus One Port Laparoscopic Surgery For Sigmoid Colon And Upper Rectal Cancer

Colorectal cancer is one of the most common cancers worldwide.Since 1990s the first laparoscopic colon resection was reported,with the times development,surgeons are encouraged to pursue more minimally invasive techniques.Compared with conventional laparoscopic surgery(CLS),Single incision laparoscopic surgery(SILS)accelerates postoperative recovery,improve cosmetic results,and reduced postoperative pain.However,SILS is a challenging and demanding technique,because of collisions or overlaps of instruments with movement,loss of triangulation,and limited in-line viewing.Single incision plus one port can overcome the technical difficulties of the procedure.Therefore,first this study analyses the learning curve of SILS+1 for sigmoid colon and upper rectal cancer retrospectively,furthermore,we design a randomized clinical trial of SILS+1 for sigmoid colon and upper rectal cancer,to compare the difference of the preioperative outcomes.Chapter 1 Multidimensional analyses of the learning curve for single-incision plus one port laparoscopic surgery for sigmoid colon and upper rectal cancerObjective:The aim of this study was to investigate the learning curve(LC)for SILS+1 for sigmoid colon and upper rectal cancer via multidimensional analysisMethod:From November 2012 to May 2014,a series of 85 consecutive patients underwent selective SILS+1 for sigmoid colon and upper rectal cancer by a single surgeon who had experience of conventional laparoscopic surgery in our institution.The LC for SILS+1 was evaluated using multidimensional analyses methods.Data for all the perioperative variables and pathologic results among the phases were compared.Result:The LC was determined had three phases:phase 1(cases 1-13)was the initial learning period;phase 2(cases 14-44)was the learning plateau period;phase 3(cases 45-85)was the competent period.The RA-CUSUM showed the peak value at the 44th case.The differences of total operating time among three phases were significant(123.2 vs.96.5 vs.91.6 mins,P<0.001).The number of harvested lymph nodes increased along with increases in the surgeon's experience(14.5 vs.20.0 vs.25.1,P=0.001).There were no significant differences in terms of rates of conversion,local recurrence or postoperative complications among the learning phases.Conlusion:The learning curve of SILS+1 for sigmoid colon and upper rectal cancer consisted of three phases.For experienced conventional five-port laparoscopic surgeon,after 13th case the learning process reached the plateau period,and the technical competence was achieved after the 44th case.Chapter ? Short-term outcomes of single-incision plus one port versus conventional laparoscopic surgery for sigmoid colon and upper rectal cancer:a randomized controlled trialObjective:To explore short-term outcomes of single-incision plus one port for sigmoid colon and upper rectal cancer.Methods:Between Oct 2014 and Dec 2016,198 patients with pathological proven sigmoid colon and upper rectal carcinoma,and clinically diagnosed as stage ?-?,were eligible for this study.Patients were randomized to receive CLS(n=98)or SILS+1(n=98).Six surgeons from our institution who had an experience of more than 100 cases laparoscopic surgery participated in the study.The perioperative outcomes between the CLS(n=93)and SILS+1(n=92)were compared on the basis of the modified intention-to-treat principle.Results:Compared with the CLS group,the SILS+1 group had a shorter total operation time(P=0.002),shorter intraperitoneal time(P=0.014),shorter total incision length(P<0.001),less estimated blood loss(P=0.009),less additional postoperative analgesics use(P=0.039)and lower visual analogue scale(VAS)scores at rest on postoperative day 3(P=0.023).The other perioperative outcomes were similar between two group.Conclusion:For experienced CLS surgeons,the SILS+1 for sigmoid colon and upper rectal cancer would be a safe and efficient alternative,and worth widely attempted.