From the Journals

Single-port laparoscopy has few complications but BMI matters


Key clinical point: BMI and length of surgery are the two most critical factors in surgical complications.

Major finding: Obese patients experienced a 1% increase in risk of surgical complications per unit value increase of BMI.

Data source: Retrospective cohort study of 587 consecutive patients undergoing single-port laparoscopy at a single academic institution.

Disclosures: Dr. Al-Niaimi reported having no financial disclosures.


AT AAGL 2017

– Single-port laparoscopy is both safe and feasible, and has the potential to decrease surgical complications and increase efficiency, according to findings presented at the AAGL Global Congress.

Ahmed N. Al-Niaimi, MD, of the University of Wisconsin–Madison, and his colleagues, conducted a retrospective cohort study analyzing 587 consecutive patients who underwent single-port laparoscopy from March 2012 to December 2016. Of the 587 patients, there were 27 clinically-relevant complications among 18 patients (3%). The complications included intensive care unit admission, reoperation, end organ damage, organ space surgical site infection, and readmission.

Dr. Ahmed Al-Niaimi of the University of Wisconsin–Madison
Dr. Ahmed Al-Niaimi

“Those factors leading to those complications are similar to the factors that cause complications in any other surgery,” Dr. Al-Niaimi said in an interview before the meeting.

Body mass index was found to be a primary contributor to surgical complications. Patients with a BMI of more than 30 kg/m2 experienced a 1% increase in the risk of surgical complications per unit value increase of BMI. This is significant because the median BMI of the patient population in the study was 33.9 kg/m2 and 57% of the study participants were considered obese or morbidly obese.

“The heavier the patient, the higher the complication rate,” Dr. Al-Niaimi said.

Surgeons who are learning single-port laparoscopy should choose patients with lower BMIs to gain efficiency in using the new technique, Dr. Al-Niaimi suggested. This will allow patients to decrease their risk of surgical complications while allowing surgeons to hone their abilities in a new surgical technique, he said.

The other prime contributor to surgical complications is the length of surgical time. The average time of surgery during the study was 156 minutes. Dr. Al-Niaimi and his colleagues found that for each 10-minute increase in surgical time, the risk of complications increased by 2%.

While the results of the study demonstrate safety in the single-port approach, Dr. Al-Niaimi said a randomized controlled trial is needed to validate the findings and determine whether single-port laparoscopy is more effective than multi-port laparoscopy.

Dr. Al-Niaimi reported having no financial disclosures.

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