Single – Incision Laparoscopic Surgery for Rectal Cancer

There have been major advances in the treatment of rectal cancer in the last two decades. Improvements in surgical instrumentation has dramatically impacted the surgical approach to rectal cancer. Particularly laparoscopic procedures have been assumed a central role in the management of benign and malignant colorectal diseases as a result of a recent paradigm shift toward minimally invasive surgery. The reasons include faster recovery times with reduced hospital stay, fewer wound-related complications, better cosmesis and oncological outcomes identical to the open traditional procedures (1,2). Although conventional laparoscopic surgery (CLS) is less traumatic than open surgery, it still continues to be associated with tissue trauma due to the size and the number of ports, each at least 1-2 cm in length (3,4). Each incision carries potential morbidity risks of bleeding, visceral organ damage, pain and formation of incisional hernia. Morover the small incisions performed for trocar placement may results in multiple scar formation and compromised cosmetic outcome (5). Single-port access (SPA) or single-incision (SILS) laparoscopic surgery has been developed as a new alternative to conventional laparoscopy. SILS technique uses a solitary incision with a specialised multilumen (3-4) port and curved or articulated instruments. This surgical innovation obviates the need for triangulation, a fundemantal requirement of conventional laparoscopy, thus minimising the number of ports. SILS surgery is emerging as a method to help decrease morbidity, optimize the cosmetic benefits of CLS and minimize the surgical trauma. Early clinical series with various procedures have demonstrated not only the feasibility but also the safety of the SILS surgery (6,7). Recently, there is an increasing trend toward the application of SILS surgery in complex abdominal operations (8). Although there has been published accounts of SILS laparoscopic colon resections and some cases of proctocolectomy and total colectomy (9-16) the literature regarding SILS laparoscopic surgery for rectal cancer is currently very rare (17,18). This is probably due to the technical challenges of the rectal dissection and to the fact that the evidence for the use of CLS in the setting of rectal cancer is limited when compared with colon cancer. This chapter will outline the current evidence for SILS as a treatment option for patients with rectal cancer and highlight the technical details of different procedures in rectal surgery.