Single Port laparoscopic combined transvaginal colorectal surgery: Experience from a single centre

S. Bischofberger, L. Traine, N. Kalak, W. Brunner

Objective

The reduction of interventional trauma is considered a main goal in modern surgery. Innovative techniques, such as Single Port laparoscopy, have been developed to further minimize surgical access trauma. Using a transvaginal access, suprapubic or umbilical incision enlargement for specimen retrieval, can be avoided.

Methods

From March 2011 to December 2013 a total of 104 Single-Port left hemicolectomies, sigmoid and rectal resection were performed (56 m, 48 f). In 21 females a combined transvaginal access and specimen retrieval was performed (Mean age 58y (36-84), mean BMI was 25.5). 57% of females had undergone previous abdominal surgery incl. hysterectomy in 5. In our study, 17 patients underwent surgery for diverticulitis, 3 for malignant intestinal neoplasia and one for benigne rectal polyp. 2 left hemicolectomies, 2 rectal resections and 17 sigmoid resections have been performed. Data was collected in a prospective single centre-database for Single Port-Procedures.

Results

Transvaginal specimen retrieval was possible in all 21 females. In 6 cases one additional trocar was used. No conversion to open surgery was necessary. Severe complication rate (Clavien-Dindo IIIb or higher) was 9.6%, one reoperated by laparoscopic approach, in one case open surgery was necessary. No vaginal complications or wound infections occurred. Mean discharge was at day 6 (no complications). Mean fascia incision length was 2.6 cm (2.1-3.6)

Conclusion

Single Port-access is an innovative and still evolving way towards further reduction of interventional trauma in colorectal surgery. The technique is safe and feasible. Transvaginal specimen retrieval offers further trauma reduction to the abdominal wall and potentially reduces incision related complications as wound infection and hernia.