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Single-port Resection for Colorectal Cancer

Single-port Resection for Colorectal Cancer. J Hornsby, B Carrick, DK Garg , TS Gill University Hospital of North Tees Colorectal NSSG Education & Audit Day 17/05/2013. 1806 Bozzini’s “Lichtleiter“ 1 1 st laparoscopy 1936 Lap. tubal ligation Lap.Cholecystectomy 2

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Single-port Resection for Colorectal Cancer

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  1. Single-port Resection for Colorectal Cancer J Hornsby, B Carrick, DK Garg, TS Gill University Hospital of North Tees Colorectal NSSG Education & Audit Day 17/05/2013

  2. 1806 Bozzini’s “Lichtleiter“1 1st laparoscopy 1936 Lap. tubal ligation Lap.Cholecystectomy2 2000s Laparoscopic colorectal surgery, Robotic surgery, Single port access, natural orifice transluminal endoscopic surgery Evolution of Laparoscopic Surgery 1Bush RB (1974). Urology 3(1): 119-123. 2Reynolds W (2001): “The first laparoscopic cholecystectomy”. JSLS 5(1): 89-94.

  3. Laparoscopic Colorectal Cancer Surgery • Reduced blood loss • Less pain • Faster recovery • Shorter length of stay • Comparable morbidity & mortality1 • Oncologically safe2 • Better cosmetic results • Gold standard BJS 97(11) 211 1Reza MM (2006): BJS 93(8): 921-928. 2Jayne DG (2010): BJS 97(11): 1638-1645.

  4. Better cosmesis than conventional laparoscopy Technically challenging Learning curve Comparative outcomes with conventional laparoscopic in audit of all colorectal cases1 1. Kanakala et al. Techniques in coloproctology. 2012 SPA laparoscopic surgery

  5. Single Port Laparoscopic Resections for Colon Cancer at North Tees • Single port resections for colorectal cancer since November 2009 • Experience of > 100 benign cases • Retrospective audit of all single port resections for colorectal cancer • Data from notes, Theatreman, pathology system

  6. Outcomes • Patient profile • Operative time • Length of stay • Morbidity and mortality • Dukes stage • Lymph node yield

  7. Cases • DG 10 cases • TG 21 cases

  8. Age Mean 67.9 Median 67 Range 34 - 94

  9. BMI: Mean 24 (17.9-32.8), Median 24.8 • 4 patients had documented previous abdominal surgery

  10. Gender ASA

  11. Operative time • Mean 140 mins (85-210) • R hemi 135 mins (85-210) • L hemi/AR 156 mins (104-170)

  12. Length of Stay • Mean 5.8 days • Median 4 • Range 3 – 25

  13. Morbidity & Mortality • No 30 day mortality, no leaks • 2 (6.5%) wound infections • 1 (3.2%) collection requiring US guided drainage • 2 extended hospital stays

  14. Dukes stage

  15. Lymph node yield • Mean 21.5, median 17, range 5-92 • 6 (19.4%) less than 12

  16. Conclusion • Initial results indicate that this technique appears to be safe without excessive operating times and recovery time • Further audits required with longer follow up and comparison with conventional laparoscopic resections

  17. Dukes Stage

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