Meta-analysis Of The Effect Of Single-incision Laparoscopic Surgery In Colorectal Surgery

Background:Since the successful implementation of the first laparoscopic colorectal resection in the world by Jacobs M^[1]at the end of the 20th century,the technology has gradually been applied in various parts of the world.Based on this clinical and clinical comparison of the efficacy of laparotomy Research is also conducted worldwide^[2],the results confirmed the safety and feasibility of the technology.Nowadays,with the rapid improvement of people's material living standards,the demand for postoperative"slight incisions"or even total incisions on the surface of the body gradually increases,and the current laparoscopic technology has failed to meet the actual needs of the vast majority of patients.We have developed a natural orifice transluminal endoscopic surgery?NOTES?^[3],which can achieve the true sense of the body without a surgical incision,but due to cost and technical problems,NOTES has not yet Can be widely used.However,the single-incision laparoscopic surgery?SILS?,as an intermediate of NOTES development,has aroused the interest of clinicians at home and abroad.It only needs a body surface incision and can also use the human body of the natural channels,such as the umbilicus incision to carry out surgical operations,it can not only significantly reduce the number of incisions to achieve better cosmetic results,but also has to accelerate postoperative recovery,reduce the physical and psychological trauma caused by surgery and so on,but also to avoid the NOTES expensive surgery,technical difficulties and other shortcomings,and related technologies can be traditionally laparoscopic grafting over,so you can save a lot of the surgeon and the actual learning time,which can make the technology better service for the majority of patients,improve the quality of life after surgery.Purposes:Evidence-based medicine method is used to systematically evaluate the differences between single-incision laparoscopy and multi-incision laparoscopy in colorectal resection,so as to explore the advantages and value of single-incision laparoscopy in colorectal surgery in China,as well as to provide some help for the clinical application of this technology.Methods:Chinese and English studies were published in Pubmed,Wan Fang,CNKI and other databases by using electronic computers to compare single-incision laparoscopic surgery and multi-incision laparoscopic colorectal resection as of december 2017.The quality of the literature is evaluated,and the required data is extracted from it,the RevManager?5.3version?and the R Project for Statistical Computing?3.4.4version?data analysis software provided by the Cochrane collaboration network is used for statistical analysis.Result:A total of 10 RCTs about 884 patients were included,including 437 in the single-incision laparoscopic group?SILS?and 447 in the multi-incision laparoscopic group?MILS?.Meta-analysis results showed that the time of first postoperative exhaustion?WMD=-0.52,95%CI:-0.63^-0.40,P<0.00001??hospital stay?WMD=-1.59,95%CI:-2.75^-0.42,P<0.007??incision size?WMD=-1.85,95%CI:-3.02^-0.68,P=0.002?,and the number of detected lymph nodes?WMD=0.79,95%CI:0.06¹.51,P=0.03?was statistically significant,the SILS group had better indicators than the MILS group,but the two groups were in operation time?WMD=-0.82,95%CI:-14.23¹2.58,P=0.90?.intraoperative blood loss?WMD=1.45,95%CI:-6.00⁸.91,P=0.70?,postoperative total complications?OR=0.86,95%CI:0.58¹.28,P=0.47?,near distance margin distance?WMD=-0.27,95%CI:-1.79¹.24,P=0.72;WMD=-0.35,95%CI:-0.91⁰.20,P=0.21?and 1-year and3-year overall survival rate after follow-up?OR=1.61,95%CI:0.53⁴.93,P=0.41;OR=0.87,95%CI:0.42¹.81,P=0.71?the difference was not statistically significant.Conclusions:Compared with the widely used traditional multi-incision laparoscopic surgery,single-incision laparoscopy is not only safe,reliable and feasible,but also has its own advantages in accelerating patients'postoperative recovery and cosmetic reduction.In addition,although there is still a lack of the results of medium and long term results,but in the short term effect,both have similar surgical results,so single-incision laparoscopy is worth further research and promotion in colorectal surgery.