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Surg Innov. 2015 Feb;22(1):46-53. doi: 10.1177/1553350614529668. Epub 2014 Apr 14.

Single-access laparoscopic rectal resection versus the multiport technique: a retrospective study with cost analysis.

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General and Mininvasive Surgical Unit, San Camillo Hospital, Trento, Italy Department of Surgical Specialities and Nephrology, University of Naples Federico II, Naples, Italy
Multidisciplinary Department of Medical, Surgical and Dental Sciences, Second University of Naples, Naples, Italy.
General and Mininvasive Surgical Unit, San Camillo Hospital, Trento, Italy.
General, Laparoscopic and Robotic Surgical Unit, Monaldi Hospital, Naples, Italy.



Single-access laparoscopic surgery is not used routinely for the treatment of colorectal disease. The aim of this retrospective cohort study is to compare the results of single-access laparoscopic rectal resection (SALR) versus multiaccess laparoscopic rectal resection with a mean follow-up of 24 months.


This retrospective cohort study enrolled 42 patients. Between January 2010 and June 2012, 21 SALRs were performed. These patients were compared with a group of 21 other patients who had undergone multiport laparoscopic rectal resection. This control group had the same exclusion criteria and patient demographics. Short-term outcomes were reassessed with a mean follow-up of 2 years. Statistical analysis included the Student t test and Fisher's exact test. Finally, we performed a differential cost analysis between the 2 procedures.


Exclusion criteria, patient demographics, and indication for surgery were similar in both groups. The conversion rate was 0% in both groups. There were no intraoperative complications or deaths. Bowel recovery was similar in both groups. No interventions, readmissions, or deaths were recorded at 30 days' follow-up. At a mean follow-up of 24 months, all the patients with a preoperative diagnosis of cancer are still alive and disease free. Considering the selected 3 items, the mean cost per patient for single-access laparoscopic surgery and multiple-access laparoscopic surgery were estimated as 7213 and 7495 Euros, respectively.


We think that SALR could be performed in selected patients by surgeons with high multiport laparoscopic skills. It is compulsory by law to evaluate outcomes and cost-effectiveness by using randomized controlled trials.


Single-incision laparoscopy; laparoscopic surgery; minimally invasive surgery; rectal resection

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