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Single-incision Laparoscopy Versus Multiport Laparoscopy for Colonic Surgery

A Multicenter, Double-blinded, Randomized Controlled Trial

Maggiori, Léon, MD, PhD*; Tuech, Jean Jacques, MD, PhD; Cotte, Eddy, MD, PhD; Lelong, Bernard, MD§; Denost, Quentin, MD, PhD; Karoui, Mehdi, MD, PhD||; Vicaut, Eric, MD, PhD**; Panis, Yves, MD, PhD*

doi: 10.1097/SLA.0000000000002836

Objective: To compare outcome of single-port laparoscopy (SPL) and multiport laparoscopy (MPL) laparoscopy for colonic surgery.

Summary of Background Data: Benefits of SPL over MPL are yet to be demonstrated in large randomized trials.

Methods: In this prospective, double-blinded, superiority trial, patients undergoing laparoscopic colonic resection for benign or malignant disease were randomly assigned to SPL or MPL (NCT01959087). Primary outcome was length of theoretical hospital stay (LHS).

Results: One hundred twenty-eight patients were randomized and 125 analyzed: 62 SPL and 63 MPL, including 91 right (SPL: n = 44, 71%; MPL: n = 47, 75%) and 34 left (SPL: n = 18, 29%; MPL: n = 16, 25%) colectomies, performed for Crohn disease (n = 53, 42%), cancer (n = 36, 29%), diverticulitis (n = 21, 17%), or benign neoplasia (n = 15, 12%). Additional port insertion was required in 5 (8%) SPL patients and conversion to laparotomy occurred in 7 patients (SPL: n = 3, 5%; MPL: n = 4, 7%; P = 1.000). Total length of skin incision was significantly shorter in the SPL group [SPL: 56 ± 41 (range, 30–300) mm; MPL: 87 ± 40 (50–250) mm; P < 0.001]. Procedure duration, intraoperative complication rate, postoperative 30-day morbidity, postoperative pain, and time to first bowel movement were similar between the groups, leading to similar theoretical LHS (SPL: 6 ± 3 days; MPL: 6 ± 2; P = 0.298). At 6 months, quality of life was similar between groups, but patients from the SPL group were significantly more satisfied with their scar aspect than patients from the MPL group (P = 0.003).

Conclusion: SPL colectomy does not confer any additional benefit other than cosmetic result, as compared to MPL.

*Colorectal Surgery Department, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, University Paris VII, Clichy, France

Department of Digestive Surgery, CHU Rouen, Rouen University, Rouen, France

Department of Digestive Surgery, CHU Lyon-Sud, Lyon University, Lyon, France

§Department of Oncological Surgery, Institut Paoli-Calmettes, Marseille, France

Colorectal unit, Hôpital Haut Lévêque, CHU Bordeaux, University of Bordeaux, Bordeaux, France

||Department of Digestive and Hepato-Pancreato-Biliary Surgery, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Pierre & Marie Curie University (Paris VI), Paris, France

**Department of Clinical Research, Hôpital Lariboisière, Assistance publique-Hôpitaux de Paris, University Paris VII, Paris, France.

Reprints: Yves Panis, MD, PhD, Service de Chirurgie Colorectale, Pôle des Maladies de l’Appareil Digestif, Hôpital Beaujon – Assistance Publique - Hôpitaux de Paris (APHP), Université Paris VII (Denis Diderot), 100 boulevard du Général Leclerc, 92118 Clichy cedex, France. E-mail:

This study was financially supported by a grant of the Programme Hospitalier de Recherche Clinique (PHRC) from the French Minister of Health.

This study was presented at the ESA meeting 2018 in Trieste, Italy.

The authors report no conflicts of interest.

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