Objective To evaluate the effectiveness and safety of single-incision video-assisted thoracic surgery versus conventional multiple ports video-assisted thoracic surgery in the treatment of lung cancer as well as providing reference for clinical decision-making. Methods We searched the Cochrane Library, PubMed, EMbase, CBM, CNKI, VIP, Wanfang ect until March 2017 to collect randomized controlled trials (RCTs), cohort studies, and case-control studies comparing single-incision with conventional multiple ports video-assisted thoracic surgery for lung cancer.Two reviewers independently screened and selected literatures according to inclusion and exclusion criteria. Then data extraction and quality assessment of included studies were conducted. RevMan 5.3 software was used for meta-analysis. Results Twenty-six cohort studies (3 053 patients) were included. The quality of the included studies was high with score more than five.Meta-analysis showed that single-incision video-assisted thoracic surgery had shorter thoracic drainage time (MD=–0.71, 95% CI –1.03 to –0.39), shorter hospitalization time (MD=–0.92, 95% CI –1.66 to –0.19), lower pain scores 1 day after surgery (MD=–0.65, 95% CI –0.90 to –0.40), lower pain scores 3 days after surgery (MD=–0.90, 95% CI –1.16 to –0.64), lower pain scores 7 days after surgery (MD=–1.24, 95% CI –1.90 to –0.57), less number of lymph node dissection (MD=–0.72, 95% CI –1.35 to –0.10), less total drainage fluid (MD=–108.60, 95% CI –180.42 to –36.79) and shorter length of surgical incision (MD=–2.74, 95% CI –3.57 to –1.90) than conventional multiple ports video-assisted thoracic surgery. But the differences between the two groups in operation time, intraoperative blood loss, postoperative complications were not statistically significant. Conclusion Single-incision video-assisted thoracic surgery is safer and better in patient's compliance than conventional multiple ports video-assisted thoracic surgery in the treatment of lung cancer. But there is no significant difference in operation time, intraoperative blood loss, or postoperative complications. It still needs large-scale, high-quality studies to demonstrate its effectiveness and safety.
ObjectiveTo compare clinical efficacy of single-incision laparoscopic surgery (SILS) and conventional laparoscopic surgery (CLS) in treatment of colorectal cancer.MethodsThe Pubmed, Embase, Cochrane library, CBM, CNKI, VIP, and Wanfang Data were searched to collect the comparative study of the SILS and CLS in the treatment of colorectal cancer. The data were extracted and evaluated by the RevMan 5.3 software.ResultsEventually, 13 articles were included, including 3 randomized controlled trials and 10 case-control studies with a total of 1 466 patients. The meta-analysis results suggested that the SILS could shorten the postoperative hospital stay [MD=–0.63, 95% CI (–1.10, –0.16), P=0.009] and time to the first flatus [MD=–0.23, 95% CI (–0.33, –0.13), P<0.000 01] and the lymph node dissection was relatively completed [MD=0.77, 95% CI (0.05, 1.48), P=0.04] as compared with the CLS. In the total complications of surgery [OR=0.73, 95% CI (0.51, 1.03), P=0.08], operation time [MD=–0.33, 95% CI (–11.36, 10.69), P=0.95], intraoperative blood loss [MD=5.61, 95% CI (–4.20, 15.43), P=0.26], conversion to laparotomy [OR=1.06, 95% CI (0.18, 6.13), P=0.95], distance between tumor and proximal margin [MD=0.11, 95% CI (–0.48, 0.69), P=0.71], distance between tumor and distal margin [MD=0.32, 95% CI (–0.23, 0.87), P=0.25] had no statistically significant differences between the SILS and CLS.ConclusionsSILS is safe and effective for radical resection of colorectal cancer. However, results of study still need to be validated by a randomized controlled trial with a large sample designed strictly.
With the upgrading of minimally invasive surgical concepts and laparoscopic equipment for gastric cancer, single-incision laparoscopic surgery (SILS) had emerged as a new focus of research in gastric cancer surgery. SILS offered advantages such as reduced damage, superior cosmetic outcomes, decreased postoperative pain, and faster recovery as compared with traditional laparoscopic gastrectomy. However, its level of difficulty limited its further promotion and application. Although numerous studies supported the safety and feasibility of SILS, more high-level evidence-based medical research was required to endorse its widespread use. The author reviewed the development history, current status, and prospects of SILS laparoscopic gastric cancer surgery.
Objective To systematically evaluate the efficacy and safety of Single-incision thoracoscopic surgery (SITS) and two-port video-assisted thoracoscopic surgery (2P-VATS) in the treatment of spontaneous pneumothorax. Methods The databases of CNKI, PubMed, The Cochrane Libray, Web of Science, EMbase, Wanfang and Chinese Medical Association were searched by computer. Literature on SITS treatment of spontaneous pneumothorax from the establishment of the database to March 2023. The data are processed with RevMan 5.4.1. Results Finally, 107 studies were included, including 35 RCTs, 2 cohort studies, and 70 case-control studies. Meta analysis results show that compared to 2P-VATS and three port video assisted thoracoscopic surgery (3P-VATS), SITS had a shorter surgical time [SMD=–0.53, 95%CI (–0.90, –0.16), P=0.005], less intraoperative bleeding [SMD=–1.58, 95%CI (–1.93, –1.22), P<0.000 01; SMD=–1.59, 95%CI (–2.03,–1.14), P<0.000 01], shorter postoperative hospitalization time [SMD=–1.05, 95%CI (–1.29,–0.82), P<0.000 01; SMD=–1.08, 95%CI (–1.39,–0.77), P<0.000 01], and shorter postoperative drainage (catheterization) time [SMD=–0.75, 95%CI (–1.00,–0.50), P<0.000 01; SMD=–1.23, 95%CI (–1.72,–0.75), P<0.000 01], fewer postoperative complications [OR=0.34, 95%CI (0.26,0.45), P<0.000 01; OR=0.47, 95%CI (0.33,0.68), P<0.000 1], fewer postoperative recurrences [OR=0.50, 95%CI (0.33,0.75), P=0.000 8], and lighter postoperative pain [SMD=–1.71, 95%CI (–1.98,–1.45), P<0.000 01; SMD=–2.02, 95%CI (–2.46,–1.59), P<0.000 01]. Compared with 3P-VATS, 2P-VATS had less intraoperative bleeding [SMD=–1.02, 95%CI (–1.81,–0.22), P=0.01] , shorter postoperative hospitalization time [SMD=–0.59, 95%CI (–1.11,–0.06), P=0.03], shorter postoperative drainage (catheterization) time [SMD=–0.46, 95%CI (–0.85,–0.08), P=0.02], fewer postoperative complications [OR=0.36, 95%CI (0.22,0.59), P<0.000 1] , and lighter postoperative pain [SMD=–0.80, 95%CI (–1.08,–0.53), P<0.000 01]. Conclusion SITS and 2P-VATS are an effective and safe method for the treatment of spontaneous pneumothorax and worthy of further promotion and application in clinical practice. Due to limitations in the quantity and quality of included studies, the above conclusions require more large-sample, high-quality studies to be verified.
ObjectiveTo compare the differences in surgical efficiency, surgical safety, aesthetic outcomes, and oncological safety between axillary single-incision endocsopic breast-conserving surgery (ASIEBS) and conventional open breast-conserving surgery (COBS), and to evaluate the clinical value of ASILBCS based on the “HUAXI hole 3” technique. MethodsA retrospective cohort study was conducted on the clinicopathologic data of patients who underwent breast-conserving surgery for breast cancer at West China Hospital of Sichuan University from January 2021 to September 2024. The patients were assigned into an ASILBCS group and a COBS group based on the surgical approach. Both groups received standardized surgical treatment and postoperative follow-up. The observation indicators included baseline characteristics, intraoperative data, postoperative complications, aesthetic outcome (by Ueda score and Harris score evaluation), and oncological safety (local recurrence and distant metastasis). ResultsA total of 67 patients were enrolled, with 41 in the ASIEBS group and 26 in the COBS group. There was no statistically significant differences in the comparison of other baseline data between the two groups (P>0.05), except for the proportions of patients with diabetes mellitus and those positive for human epidermal growth factor receptor 2 (P＜0.05). The ASIEBS group showed superior aesthetic outcomes compared to the COBS group (Ueda score: P=0.013; Harris score: P=0.047). However, the ASIEBS group had higher median total hospitalization costs (12 779.00 yuan vs. 12 354.50 yuan, Z=–2.16, P=0.03). The median follow-up time was 31.43 months in the ASIEBS group and 21.20 months in the COBS group (Z=–2.36, P=0.02). During follow-up, only one patient with local recurrence occurred in the ASIEBS group, and no distant metastasis or death event was observed in both groups. ConclusionThe ASIEBS based on the “HUAXI hole 3” technique is comparable to COBS in terms of surgical efficiency, surgical safety, and oncological safety, while offering superior aesthetic outcomes.