SINGLE-PORT RESECTION VERSUS MULTIPORT LAPAROSCOPY: A SYSTEMATIC REVIEW OF ACCESS, SAFETY AND ONCOLOGICAL MARGINS IN DIFFICULT-TO-ACCESS TUMORS
DOI:
https://doi.org/10.18623/rvd.v23.6183Keywords:
Laparoscopy (Single-Port Laparoscopy), Laparoscopy (Multiport Laparoscopy), Oncological Margins, Minimally Invasive Surgery, Challenging Access TumorsAbstract
Background: Minimally invasive oncologic surgery has been developed to minimize abdominal wall trauma using single-port laparoscopy. Nonetheless, in tumors in anatomically difficult areas such as posterior liver segments, the deep pelvis and upper mediastinum issues, there remain concerns over the instrument triangulation, exposure and integrity of the oncological margins. This systematic review critically analyzes the comparative feasibility of access, perioperative safety and oncological adequacy of single-port laparoscopic versus multiport laparoscopic resection of difficult-to-access solid tumors. Methods: A systematic review was carried out based on PRISMA guidelines. Pubmed, scopus, web of science and Cochrane library were searched from 2016 to april 2026 using the terms single-port laparoscopy, multiport laparoscopy, oncological margins and difficult access tumours. Adults that reported oncological or perioperative outcomes of solid tumor resections were eligible to participate in comparative and cohort studies. Cases, pediatric studies and non-oncological procedures were excluded. The outcomes of interest were the R0 resection rates, open surgery conversion, operative time, complication rates and margin width. Findings: Forty-eight studies were included that included randomized controlled trials, propensity-matched cohorts and registry analyses. There was heterogeneous and mainly retrospective evidence. Single-port laparoscopy was found to have R0 resection rates similar to multiport laparoscopy (range 88% to 100%) and less early postoperative pain and length of stay. Nevertheless, single-port methods proved to be more conversion-efficient (up to 35% in extended pancreatic resections) and have smaller parenchymal margins (e.g., 5 mm vs. 9.5 mm in posterosuperior liver segments, p=0.012). Registry data showed that single-port transanal total mesorectal excision was associated with a better sphincter preservation in low rectal cancer without a loss of circumferential resection margin positivity (5.1% vs. 5.4, odds ratio 4.11, p<0.001) which is a niche in which single-port access has an anatomical benefit. Multiport laparoscopy was always associated with better triangulation and lower intraoperative difficulty scores and conversion rates were less than 10% in even complex hepatectomy and pancreatectomy groups. Conclusions: Laparoscopy (single-port) has significant recovery and cosmetic advantages in well-selected patients who have peripherally located tumors. Nevertheless, in lesions in anatomically limited areas where precision of margins and dexterity of the instruments are of paramount importance, multiport laparoscopy is the more dependable platform. The existing evidence has shortcomings in terms of selection bias and lack of long-term oncological follow-up. Evidence-based indications are urgently needed and randomized trials that are high quality and stratified by tumor location and difficulty are needed.
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