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Page 4 of 8 Ishida et al. Mini-invasive Surg 2018;2:31 I http://dx.doi.org/10.20517/2574-1225.2018.53

Table 1. Retrospective studies comparing reduced port laparoscopic surgery and conventional multiport laparoscopic surgery
(CMLS) for colorectal cancer (CRC)
Total patients included
Author Publication year Reference Accrual Difference seen in RPS
(RPS vs. CMLS)
Kang et al. 2018 31 73 vs. 111 2011-2017 Operation time Shorter
Gas passage time Longer
Song et al. 2016 32 32 vs. 217* 2011-2013 Operation time Shorter
Blood loss Less
Gas passage time Shorter
Pain Less
Liu et al. 2017 27 48 vs. 48** 2011-2014 3Y DFS N.S.
3Y OS N.S.
Operation time Shorter
Total incision length Shorter
Time to liquid diet Shorter
Time to ambulation Shorter
Discharge Less
Pain Less
Postoperative CRP and Lower
IL-6 levels
Cosmesis Better
Kawamata et al. 2014 33 20 vs. 20 2010-2012 Operation time N.S.
Postoperative neutrophil Lower
counts
Postoperative body Lower
temparature

RPS: Reduced-port laparoscopic surgery

ambulation [27,31] . In addition, RPS leads to less postoperative pain and better cosmetic results than does
CMLS because of the shorter total incision length [27,31] . Therefore, patients who undergo RPS have better
postoperative outcomes. However, the estimated blood loss, morbidity rate, conversion rate, and number
of harvested lymph nodes were comparable, suggesting that RPS is a feasible and safe procedure in the
early postoperative stage [27,30] . Furthermore, the postoperative neutrophil count, C-reactive protein level,
interleukin-6 level, and body temperature were significantly lower after RPS compared with CMLS [27,32] ,
which may accelerate recovery. Another advantage of RPS may be its cost effectiveness. The instrument
cost for RPS may be lower due to the reduced number of trocars required; however, previous studies
have not evaluated this factor. A shortened hospital stay and decreased analgesic use may also reduce the
cost [34,35] .

A MIAP can be placed at the ileostomy site and the excised specimen can be brought out during a reduced
port laparoscopic low anterior resection with diverting ileostomy. Furthermore, a drainage tube can be
[36]
placed via the additional port . The use of MIAP as the ileostomy site represents a minimally invasive
approach that results in a scarless procedure.

Superiority of RPS over SILS
[37]
RPS for CRC may have several advantages over CMLS. Since Burcher et al. performed the first SILS for
colorectal diseases, it has become widely used because of technical advancements. However, SILS has a risk
of collisions between instruments and is limited by use of triangular tissue traction [21,24,38] ; consequently,
[36]
SILS is used infrequently worldwide . In contrast, the additional port created during RPS reduces the
risk of collision between surgical instruments and the laparoscope, as well as shortening the operation
[27]
time compared with SILS . Therefore, RPS involves fewer technical difficulties than does SILS. Moreover,
RPS has other advantages over SILS, such as the convenience of an intracorporeal suture and stable drain
placement via the additional port.