European association for endoscopic surgery (EAES) consensus statement on single-incision endoscopic surgery

Salvador Morales-Conde, Andrea Peeters, Yannick M. Meyer, Stavros A. Antoniou, Isaías Alarcón del Agua, Alberto Arezzo, Simone Arolfo, Amir Ben Yehuda, Luigi Boni, Elisa Cassinotti, Giovanni Dapri, Tao Yang, Sofie Fransen, Antonello Forgione, Shahab Hajibandeh, Shahin Hajibandeh, Michele Mazzola, Marco Migliore, Christof Mittermair, Doris MittermairAntonio Morandeira-Rivas, Carlos Moreno-Sanz, Andrea Morlacchi, Eran Nizri, Myrthe Nuijts, Jonas Raakow, Francisco M. Sánchez-Margallo, Juan A. Sánchez-Margallo, Amir Szold, Helmut Weiss, Michael Weiss, Ricardo Zorron, Nicole D. Bouvy

Research output: Contribution to journalArticle

Abstract

Background: Laparoscopic surgery changed the management of numerous surgical conditions. It was associated with many advantages over open surgery, such as decreased postoperative pain, faster recovery, shorter hospital stay and excellent cosmesis. Since two decades single-incision endoscopic surgery (SIES) was introduced to the surgical community. SIES could possibly result in even better postoperative outcomes than multi-port laparoscopic surgery, especially concerning cosmetic outcomes and pain. However, the single-incision surgical procedure is associated with quite some challenges. Methods: An expert panel of surgeons has been selected and invited to participate in the preparation of the material for a consensus meeting on the topic SIES, which was held during the EAES congress in Frankfurt, June 16, 2017. The material presented during the consensus meeting was based on evidence identified through a systematic search of literature according to a pre-specified protocol. Three main topics with respect to SIES have been identified by the panel: (1) General, (2) Organ specific, (3) New development. Within each of these topics, subcategories have been defined. Evidence was graded according to the Oxford 2011 Levels of Evidence. Recommendations were made according to the GRADE criteria. Results: In general, there is a lack of high level evidence and a lack of long-term follow-up in the field of single-incision endoscopic surgery. In selected patients, the single-incision approach seems to be safe and effective in terms of perioperative morbidity. Satisfaction with cosmesis has been established to be the main advantage of the single-incision approach. Less pain after single-incision approach compared to conventional laparoscopy seems to be considered an advantage, although it has not been consistently demonstrated across studies. Conclusions: Considering the increased direct costs (devices, instruments and operating time) of the SIES procedure and the prolonged learning curve, wider acceptance of the procedure should be supported only after demonstration of clear benefits.

Original languageEnglish
Pages (from-to)996-1019
Number of pages24
JournalSurgical Endoscopy
Volume33
Issue number4
DOIs
Publication statusPublished - Apr 15 2019

Keywords

  • Consensus
  • Laparoscopic surgery
  • Laparoscopy
  • Recommendation
  • Single incision
  • Statement

ASJC Scopus subject areas

  • Surgery

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    Morales-Conde, S., Peeters, A., Meyer, Y. M., Antoniou, S. A., del Agua, I. A., Arezzo, A., Arolfo, S., Yehuda, A. B., Boni, L., Cassinotti, E., Dapri, G., Yang, T., Fransen, S., Forgione, A., Hajibandeh, S., Hajibandeh, S., Mazzola, M., Migliore, M., Mittermair, C., ... Bouvy, N. D. (2019). European association for endoscopic surgery (EAES) consensus statement on single-incision endoscopic surgery. Surgical Endoscopy, 33(4), 996-1019. https://doi.org/10.1007/s00464-019-06693-2