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Comparative Effectiveness Review of Single-Incision Laparoscopic Surgery (SILS) for Colorectal Procedures: A Review of Reviews

March 26, 2018

Health Problem: Colorectal diseases encompass a broad range of conditions that can vary in severity from mildly irritating to life threatening. Common indications requiring surgical intervention for curative intent include colorectal cancer, inflammatory bowel disease, and diverticular disease.

Technology Description: Single-incision laparoscopic surgery (SILS) for colorectal disease is an emerging surgical technique that requires only 1 subumbilical incision for colorectal resection. Specialized port systems are available to facilitate SILS or the surgical team may use standard laparoscopic devices to perform this surgery. All of the procedures utilize pneumoperitoneum (gas used to expand the abdomen and permit visualization during surgery) and instruments for viewing the surgical area and for suturing. SILS is an alternative to standard multi-incision laparoscopic surgery (MILS).

Controversy: While SILS is touted to be a scarless surgery with the benefits of less pain and shorter hospital length of stay, it has the disadvantages of limited ability to move and triangulate surgical instruments; a more challenging platform for intracorporeal suturing; and longer operating times, especially during the surgeon’s learning phase.

Key Questions:

  • Are SILS procedures effective for treating benign and malignant colorectal disease?
  • How do SILS procedures compare with conventional MILS procedures for colorectal disease?
  • Are SILS procedures for colorectal disease safe?
  • Have definitive patient selection criteria been identified for the SILS procedure?