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A randomized pilot study on single-port versus conventional laparoscopic rectal surgery: effects on postoperative pain and the stress response to surgery

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Abstract

Background

Potential benefits of single-port laparoscopic surgery may include improved cosmetic results, less postoperative pain, surgical trauma and faster recovery. Results of randomized prospective studies with a focus on single-port rectal surgery have not yet been presented. The aim of the present study was to compare single-port and conventional laparoscopic surgery for rectal cancer in terms of short-term outcomes including postoperative pain and trauma-induced changes in certain bioactive substances.

Methods

Patients with non-metastasized rectal cancer were prospectively randomized to single-port (n = 20) or conventional laparoscopic rectal surgery (n = 20). Postoperative pain was assessed at rest, at coughing and during mobilization, with a numeric pain ranking score and was recorded at 6 h after the operation and subsequently every morning daily for 4 days. Levels of C-reactive protein (CRP), interleukin-6 (IL-6) and tissue inhibitor of metalloproteinases-1 (TIMP-1) were determined. Blood samples were collected preoperatively (baseline), and 6, 24, 48, 72 and 96 h after skin incision.

Results

Pain scores were significantly reduced in the single-port group on postoperative days 2, 3 and 4 during coughing and mobilization. In addition, the patients in the single-port group suffered significantly less pain at rest at 6 h after surgery and on postoperative days 1, 3 and 4. The levels of the three markers increased significantly after surgery. The increase was similar between groups for plasma IL-6 and TIMP-1 at all time points, while the CRP levels were significantly lower in the single-port group at 6 (p < 0.001) and 24 h (p < 0.05) after skin incision. Abdominal incisions lengths were significantly shorter in the single-port group (p = 0.001). There was no significant difference between groups in operating time and blood loss, morbidity or mortality rate. The short-term oncological outcome in the two groups was similar.

Conclusions

Single-port rectal surgery may reduce postoperative pain. Although CRP levels were lower at some time points, results of the present randomized, pilot study suggest that the trauma-induced inflammatory response of single-port operations may be similar to the trauma-induced inflammatory response of conventional laparoscopic surgery.

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Acknowledgments

The authors are indebted to research nurse Cathrine H. Bachmann for help with blood sample collection and handling. The authors would also like to express our gratitude to Nicolai B. Foss, MD, DMSc from the Department of Anaesthesiology for his advice and review of the manuscript. Funding for this work was received from: The Kornerup Fund, The Aase and Ejnar Danielsen Fund, The Kathrine and Vigo Skovgaard Fund.

Conflict of interest

None.

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Authors and Affiliations

  1. Department of Surgical Gastroenterology 360, Copenhagen University Hospital Hvidovre, Kettegaard Allé 30, 2650, Hvidovre, Denmark

    O. Bulut, K. K. Aslak, K. Levic, C. B. Nielsen, E. Rømer & H. J. Nielsen

  2. Department of Clinical Biochemistry, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark

    S. Sørensen

  3. The Finsen Laboratory, Rigshospitalet and Biotech Research and Innovation Centre (BRIC), University of Copenhagen, Copenhagen, Denmark

    I. J. Christensen

  4. Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark

    O. Bulut & H. J. Nielsen

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  1. O. Bulut
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Correspondence to O. Bulut.

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Bulut, O., Aslak, K.K., Levic, K. et al. A randomized pilot study on single-port versus conventional laparoscopic rectal surgery: effects on postoperative pain and the stress response to surgery. Tech Coloproctol 19, 11–22 (2015). https://doi.org/10.1007/s10151-014-1237-6

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  • DOI: https://doi.org/10.1007/s10151-014-1237-6

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