Single-incision laparoscopy for colorectal resection: a systematic review and meta-analysis of more than a thousand procedures

Aim  Single-incision laparoscopy for colorectal surgery is of growing importance. The experience of colorectal resection through single-incision laparoscopic surgery was assessed, including the patient outcomes. Method  A meta-analysis was performed of studies comparing single-incision laparoscopic with multiport laparoscopy. Endpoints included conversion to laparotomy, operation time, postoperative morbidity, length of skin incision and length of hospital stay. The MEDLINE database was searched and only comparative studies were included in the meta-analysis. Data were retrieved from full-text manuscripts. Meta-analysis was performed according to the Mantel–Haenszel method for random effects. Results  From October 2008 to December 2011, 1026 colorectal resections including 921 colonic and 105 rectal procedures using single-incision laparoscopic surgery were reported in 64 studies. Meta-analysis of the 15 comparative studies, including a total of 1075 procedures (494 single-incision and 581 multiport laparoscopies), showed no difference in conversion to open laparotomy [odds ratio (OR) 0.58 (0.24, 1.38); P = 0.22], morbidity [OR 0.84 (0.61, 1.15); P = 0.27] or operation time [weighted mean difference (WMD) −0.27 (−6.50, 5.95); P = 0.93], but a significantly shorter total skin incision [WMD −0.52 (−0.79, −0.25); P < 0.001] and a significantly shorter postoperative length of stay [WMD −0.75 (−1.30, −0.20); P = 0.008] after single-incision laparoscopic surgery compared with a multiport laparoscopic approach. Conclusion  Although only 15 nonrandomized comparative studies of varying methodology have been reported, this systematic review and meta-analysis of more than 1000 colorectal procedures suggest that single-incision laparoscopic colorectal surgery is feasible and safe.