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Invited Critique
February 16, 2009

Single-Access Laparoscopic Sigmoidectomy as Definitive Surgical Management of Prior Diverticulitis in a Human Patient—Invited Critique

Arch Surg. 2009;144(2):179. doi:10.1001/archsurg.2008.561

The authors describe a unique series of technical accomplishments combined with advanced instruments to perform a colectomy via a single 2-cm abdominal incision. These case reports add to the rapidly accruing clinical data of single-port surgical techniques and cases. The authors should be congratulated on their diligence and hard work in developing complex tasks and bringing them from the laboratory to the operating room.

The concept of single-port surgery has been widely publicized, advocated, and touted as a major improvement in laparoscopic surgical technique. This unbridled enthusiasm has continued on an emotional and subjective basis, and persists despite the lack of any objective evidence of benefit. While it is clear that we should use technical and technological advances to improve patient outcomes, the alleged benefits of cosmesis, improved wound healing and reduced inflammatory response, remain largely unproven and untested. The increased perioperative risks of prolonged operative times, decreased visualization, and difficulty with tissue manipulation have not been considered. Standard laparoscopic techniques, especially using 5-mm port sites, already have low hernia rates, low wound infection rates, and good cosmesis.

Single-port access remains a technical challenge that can be accomplished safely in humans, as demonstrated by these authors. However, the ability to perform a technically challenging human case does not support the application of this technology in a widespread manner, especially when extrapolated to a broader range of surgeons and patient scenarios. The goal of advancement of minimally invasive techniques should be to provide the benefits to a broader spectrum of patients and to improve their outcomes, such as increasing the incidence of laparoscopic over open colectomy. Continued work in single-port access surgery should be balanced, relying not only on the technical aspects of the procedure, but also on developing clear evidence of improved patient outcomes.

Correspondence: Dr Melvin, Division of General Surgery, Minimally Invasive Surgery, 410 W Tenth Ave, Doan Hall Room N729, Columbus, OH 43210 (scott.melvin@osumc.edu).

Financial Disclosure: None reported.