Ann Surg Treat Res.  2021 Feb;100(2):67-75. 10.4174/astr.2021.100.2.67.

Comparing the short-term outcomes and cost between solo single-incision distal gastrectomy and conventional multiport totally laparoscopic distal gastrectomy for early gastric cancer: a propensity score-matched analysis

• Lee B
• Youn SI
• Lee K
• Won Y
• Min S
• Lee YT
• Park YS
• Ahn SH
• Park DJ
• Kim HH

• KMID: 2512478
• DOI: http://doi.org/10.4174/astr.2021.100.2.67

Abstract

Purpose
Single-incision laparoscopic distal gastrectomy (SIDG) requires experienced camera operators for a stable image. Since it is difficult for skilled camera operators to participate in all SIDG, we began performing solo surgery using mechanical camera holders. We aimed to compare the short-term outcomes and cost between solo SIDG and conventional multiport laparoscopic distal gastrectomy (MLDG) for early gastric cancer (EGC).
Methods
From January 2014 to December 2016, a total of 938 consecutive patients underwent laparoscopic gastrectomy for EGC. Solo SIDG (n = 99) and MLDG patients (n = 198) were selected and 1:2 propensity score matching was done to compare the quality of operation and cost-effectiveness. All solo SIDG was performed by a surgeon using a camera holder, without any assistant.
Results
Mean operation time (120 ± 35.3 vs. 178 ± 53.4 minutes, P = 0.001) and estimated blood loss (24.6 ± 47.4 vs. 46.7 ± 66.5 mL, P = 0.001) were significantly lower in the solo SIDG group. Hospital stay, use of analgesics, and postoperative inflammatory markers (WBC, CRP) were similar between the 2 groups. The early (<30 days) complication rate in solo SIDG and MLDG groups was 21.2% and 23.7%, respectively (P = 0.240); the late (≥30 days) complication rate was 7.1% and 11.1%, respectively (P = 0.672). The manpower cost of solo SIDG was significantly lower than that of MLDG (P = 0.001).
Conclusion
This study demonstrated that solo SIDG performed by experienced laparoscopic surgeons is safe and feasible for EGC. Solo SIDG is expected to be a promising potential treatment for EGC.

Keyword

Cost analysis; Laparoscopy; Stomach neoplasms; Surgical wound

Figure

• 

  Fig. 1 Mean charge for the cost between solo single-incision laparoscopic distal gastrectomy (SIDG) vs. multiport laparoscopic distal gastrectomy (MLDG) groups. USD, US dollar.

Reference

1. Omori T, Tanaka K, Tori M, Ueshima S, Akamatsu H, Nishida T. Intracorporeal circular-stapled Billroth I anastomosis in single-incision laparoscopic distal gastrectomy. Surg Endosc. 2012; 26:1490–1494. PMID: 22044985.

2. Ahn SH, Son SY, Jung DH, Park DJ, Kim HH. Pure single-port laparoscopic distal gastrectomy for early gastric cancer: comparative study with multi-port laparoscopic distal gastrectomy. J Am Coll Surg. 2014; 219:933–943. PMID: 25256369.

3. Omori T, Fujiwara Y, Moon J, Sugimura K, Miyata H, Masuzawa T, et al. Comparison of single-incision and conventional multiport laparoscopic distal gastrectomy with D2 lymph node dissection for gastric cancer: a propensity score-matched analysis. Ann Surg Oncol. 2016; 23(Suppl 5):817–824. PMID: 27510844.

4. Kim SJ, Choi BJ, Jeong W, Lee SC. The feasibility of single-port laparoscopic appendectomy using a solo approach: a comparative study. Ann Surg Treat Res. 2016; 90:164–170. PMID: 26942160.

5. Velthuis S, van den Boezem PB, Lips DJ, Prins HA, Cuesta MA, Sietses C. Comparison of short-term surgical outcomes after single-incision laparoscopic versus multiport laparoscopic right colectomy: a two-center, prospective case-controlled study of 100 patients. Dig Surg. 2012; 29:477–483. PMID: 23364285.

6. Lurje G, Raptis DA, Steinemann DC, Amygdalos I, Kambakamba P, Petrowsky H, et al. Cosmesis and body image in patients undergoing single-port versus conventional laparoscopic cholecystectomy: a multicenter double-blinded randomized controlled trial (SPOCC-trial). Ann Surg. 2015; 262:728–735. PMID: 26583659.

7. Podda M, Saba A, Porru F, Pisanu A. Systematic review with meta-analysis of studies comparing single-incision laparoscopic colectomy and multiport laparoscopic colectomy. Surg Endosc. 2016; 30:4697–4720. PMID: 26905578.

8. Jaspers JE, Breedveld P, Herder JL, Grimbergen CA. Camera and instrument holders and their clinical value in minimally invasive surgery. Surg Laparosc Endosc Percutan Tech. 2004; 14:145–152. PMID: 15471021.

9. Arezzo A, Ulmer F, Weiss O, Schurr MO, Hamad M, Buess GF. Experimental trial on solo surgery for minimally invasive therapy: comparison of different systems in a phantom model. Surg Endosc. 2000; 14:955–959. PMID: 11080411.

10. Caliendo M, Kopeinig S. Some practical guidance for the implementation of propensity score matching. J Econ Surv. 2008; 22:31–72.

11. Daabiss M. American Society of Anaesthesiologists physical status classification. Indian J Anaesth. 2011; 55:111–115. PMID: 21712864.

12. Kang SH, Cho YS, Min SH, Park YS, Ahn SH, Park DJ, et al. Early experience and learning curve of solo single-incision distal gastrectomy for gastric cancer: a review of consecutive 100 cases. Surg Endosc. 2019; 33:3412–3418. PMID: 30604257.

13. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6,336 patients and results of a survey. Ann Surg. 2004; 240:205–213. PMID: 15273542.

14. Japanese Gastric Cancer Association. Japanese classi fication of gastric carcinoma: 3rd English edition. Gastric Cancer. 2011; 14:101–112. PMID: 21573743.

15. Berlth F, Bollschweiler E, Drebber U, Hoelscher AH, Moenig S. Pathohistological classification systems in gastric cancer: diagnostic relevance and prognostic value. World J Gastroenterol. 2014; 20:5679–5684. PMID: 24914328.

16. Park DJ, Lee JH, Ahn SH, Eng AK, Kim HH. Single-port laparoscopic distal gastrectomy with D1+β lymph node dissection for gastric cancers: report of 2 cases. Surg Laparosc Endosc Percutan Tech. 2012; 22:e214–e216. PMID: 22874704.

17. Ozdemir BA, Thomas RL, Soon Y. Single-port laparoscopic subtotal gastrectomy with DIα lymphadenectomy. Surg Innov. 2011; 18:NP1–NP4.

18. Suh YS, Lee HJ, Yang HK. Single incision gastrectomy for gastric cancer. Transl Gastroenterol Hepatol. 2016; 1:41. PMID: 28138608.

19. Kim SJ, Lee SC. Technical and instrumental prerequisites for single-port laparoscopic solo surgery: state of art. World J Gastroenterol. 2015; 21:4440–4446. PMID: 25914453.

20. Interleukin-6 Receptor Mendelian Randomisation Analysis (IL6R MR) Consortium. Swerdlow DI, Holmes MV, Kuchenbaecker KB, Engmann JE, Shah T, et al. The interleukin-6 receptor as a target for prevention of coronary heart disease: a mendelian randomization analysis. Lancet. 2012; 379:1214–1224. PMID: 22421340.

21. Bulut O, Aslak KK, Levic K, Nielsen CB, Rømer E, Sørensen S, 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. 2015; 19:11–22. PMID: 25380743.