Single port/incision laparoscopic surgery compared with standard three-port laparoscopic surgery for appendicectomy - a randomised controlled trial

Abstract

BackgroundLaparoscopic surgery has become the preferred approach for many procedures because of reduced post-operative pain, better recovery, shorter hospital stay and improved cosmesis. Single incision laparoscopic surgery is one of the many recent variants where either standard ports or a specially designed single multi-channel port is introduced through a single skin incision. While the cosmetic advantage of this is obvious, the evidence base for claims of reduced morbidity and better post-operative recovery is weak. This study aims to compare the effectiveness of single port/incision laparoscopic appendicectomy with standard three-port laparoscopic appendicectomy in adult patients at six weeks post-surgery. We also wish to assess the feasibility of a multicentre randomised controlled trial comparing single port/incision laparoscopic surgery with standard three-port laparoscopic surgery for other surgical techniques.Methods and designPatients diagnosed with suspected appendicitis and requiring surgical treatment will be randomised to receive either standard three-port or single incision laparoscopic surgery. Data will be collected from clinical notes, operation notes and patient reported questionnaires. The following outcomes will be considered:1. Effectiveness of the surgical procedure in terms of:•patient reported outcomes•clinical outcomes•resource use2. Feasibility of conducting a randomised controlled trial (RCT) in the emergency surgical setting by quantifying:•patient eligibility•randomisation acceptability•feasibility of blinding participants to the intervention received•completion rates of case report forms and patient reported questionnairesTrial registrationISRCTN66443895 (assigned 10 March 2011, first patient randomised 09 January 2011)

Single Port Laparoscopic Surgery- Are there Limitations of Minimal Invasive Surgery? Definition of an Opinion

“…Nevertheless, the basic question which patients take advantage of the procedure should be clarified; if this cannot achieved through RCT, at least data of all patients undergoing single port surgery should be captured in data bases to satisfy the scientific requirements. It remains the hope that ongoing trials to the various organ systems achieve a gain in knowledge [9,40,41].…”

Laparo-endoscopic single site (LESS) versus multi-port operative laparoscopy for benign adnexal masses

“…In a similar fashion, endometriosis of the surface of the urinary bladder was also removed. 21 In multiport cases, Patient kept in steep trendelenburg and lithotomy position. One assistant stand between the legs of the patient to do uterine manipulation whenever required.…”

“…Pedicles are inspected under water and with decreased pneumoperitoneum and any bleeding if present can be controlled with bipolar electrocoagulation. 20,21 All patients were reevaluated after two weeks. Patients were asked about the time taken for them to resume full domestic function and sexual activity.…”

Gasless single-port laparoscopic cholecystectomy

“…Also, being a more complex procedure, it has been deemed suitable for only nonobese patients with no history of abdominal surgery; it is not considered suitable for the acutely inflamed gallbladder. Furthermore, it is perceived that the single-port surgery requires greater operative time than CLC, while this additional burden of medical costs and safety remain undetermined [ 5 , 6 ].…”