Single-port laparoscopic rectal surgery - a systematic review.

INTRODUCTION Single-port laparoscopic surgery (SPLS) for colonic disease has been widely described, whereas data for SPLS rectal resection are sparse. This review aimed to evaluate the feasibility, safety and complication profile of SPLS for rectal diseases. METHODS A systematic literature search of PubMed and Embase was performed in September 2013 according to the PRISMA guidelines. Original reports on the use of SPLS in high and low anterior resection, Hartmann's operation and abdominoperineal resection were included. Outcome measures were intra-operative details and complications, short-term oncological outcome and early complication profile. RESULTS No randomised studies or controlled clinical studies were identified. All studies were case series or case reports. Only five studies included more than ten patients operated with SPLS, comprising a total of 120 patients. These studies formed the basis for the final analyses of outcome. Operative times ranged from 79 to 280 min. Conversion rates to conventional laparoscopic surgery and to open surgery were 12% and 2.5%, respectively. The number of harvested lymph nodes in malignant cases was 13-18. The post-operative complication rate was 25.5%. Length of hospital stay was 1-16 days. No 30-day mortality was reported. CONCLUSION Short-term results suggest that SPLS for rectal disease is feasible and safe with an acceptable complication rate when performed by experienced surgeons in selected patients. Oncological safety and the possible benefits remain to be proven. Future rectal SPLS procedures should be performed in a protocolled set-up.