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Surg Endosc. 2019 Feb 15. doi: 10.1007/s00464-019-06693-2. [Epub ahead of print]

European association for endoscopic surgery (EAES) consensus statement on single-incision endoscopic surgery.

Author information

1
Unit of Innovation in Minimally Invasive Sugery, Department of General and Digestive Surgery, University Hospital "Virgen del Rocio", Sevilla, Spain.
2
Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, Maastricht, The Netherlands.
3
Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands. y.meyer2384@gmail.com.
4
Colorectal Department, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK.
5
Department of Surgical Sciences, University of Torino, Torino, Italy.
6
Surgery division, Assaf Harofe medical center, Zeriffin, Israel.
7
Department of Surgery, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
8
Saint-Pierre University Hospital, Brussels, Belgium.
9
Department of Surgery, Laurentius Ziekenhuis Roermond, Roermond, The Netherlands.
10
Niguarda Cà Granda Hospital, Milan, Italy.
11
Department of General Surgery, Royal Bolton Hospital, Bolton, UK.
12
Department of General Surgery, Stepping Hill Hospital, Stockport, UK.
13
SJOG Hospital - PMU Teaching Hospital, Salzburg, Austria.
14
Department of Surgery, "La Mancha Centro" General Hospital, Alcázar de San Juan, Ciudad Real, Spain.
15
Department of Surgery, University of Insubria, Varese, Italy.
16
Surgery division, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
17
Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
18
Center for Innovative Surgery- ZIC, Charité - Universitätsmedizin, Chirurgische Klinik, Campus Charité Mitte/ Campus Virchow-Klinikum, Berlin, Germany.
19
Jesús Usón Minimally Invasive Surgery Centre, Cáceres, Spain.
20
Assia Medical Group, Tel Aviv, Israel.

Abstract

BACKGROUND:

Laparoscopic surgery changed the management of numerous surgical conditions. It was associated with many advantages over open surgery, such as decreased postoperative pain, faster recovery, shorter hospital stay and excellent cosmesis. Since two decades single-incision endoscopic surgery (SIES) was introduced to the surgical community. SIES could possibly result in even better postoperative outcomes than multi-port laparoscopic surgery, especially concerning cosmetic outcomes and pain. However, the single-incision surgical procedure is associated with quite some challenges.

METHODS:

An expert panel of surgeons has been selected and invited to participate in the preparation of the material for a consensus meeting on the topic SIES, which was held during the EAES congress in Frankfurt, June 16, 2017. The material presented during the consensus meeting was based on evidence identified through a systematic search of literature according to a pre-specified protocol. Three main topics with respect to SIES have been identified by the panel: (1) General, (2) Organ specific, (3) New development. Within each of these topics, subcategories have been defined. Evidence was graded according to the Oxford 2011 Levels of Evidence. Recommendations were made according to the GRADE criteria.

RESULTS:

In general, there is a lack of high level evidence and a lack of long-term follow-up in the field of single-incision endoscopic surgery. In selected patients, the single-incision approach seems to be safe and effective in terms of perioperative morbidity. Satisfaction with cosmesis has been established to be the main advantage of the single-incision approach. Less pain after single-incision approach compared to conventional laparoscopy seems to be considered an advantage, although it has not been consistently demonstrated across studies.

CONCLUSIONS:

Considering the increased direct costs (devices, instruments and operating time) of the SIES procedure and the prolonged learning curve, wider acceptance of the procedure should be supported only after demonstration of clear benefits.

KEYWORDS:

Consensus; Laparoscopic surgery; Laparoscopy; Recommendation; Single incision; Statement

PMID:
30771069
DOI:
10.1007/s00464-019-06693-2

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