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

Abstract

Background and objectiveThe aim of this study was to compare the effectiveness of single port/incision laparoscopic surgery (SPILS) with standard three-port laparoscopic surgery for appendicectomy in adults. Feasibility data was collected to evaluate generalizability to other single-port techniques such as cholecystectomy.MethodsThis was a single-center, randomized controlled trial. Participants were randomized to receive either SPILS or standard three-port laparoscopic appendicectomy. The primary patient-reported outcomes were body image and cosmesis at 6 weeks. The primary clinical outcome was pain at 1–7 days. Secondary outcomes included duration of operation, conversion rates, complication rates, use of analgesia, hospital re-admission rates, re-operation rates, and time to return to normal activities.ResultsSeventy-nine patients were randomized. Sixty-seven completed the day 1–7 diary and 53 completed the 6-week follow-up. SPILS patients answered significantly more favorably to the items in the body image scale [mean (SD) 5.6 (1.0) vs. 7.0 (3.3); −1.4 (95 % CI −2.8 to 1.5; p = 0.03)] and the cosmetic scale [18.9 (4.1) vs. 15.3 (5.8); 3.6 (95 % CI 0.7–6.5; p = 0.016)] compared with patients in the Standard group. The duration of operation was shorter for SPILS, and patients required less morphine in recovery; however, there were no statistically significant differences in other outcomes.ConclusionsPatient-reported body image and cosmesis outcomes were better, and surgical outcomes were similar following SPILS. However, the SPILS procedure is more technically demanding and may not be achievable or necessary in routine clinical care. Further assessment of the findings is needed through larger multicenter studies.

Single-incision Laparoscopic Appendectomy for acute Appendicitis using a 10-mm Laparoscope and the Glove Port Technique

“…Nevertheless, SILA generally requires a higher level of technical expertise compared to laparoscopic appendectomy with multi-port because of the scarcity of instruments or the lack of triangulation. Furthermore, SILA is performed using a 5-mm laparoscope or specialized instruments such as the umbilical port 9. Additionally, several tens of thousands of dollars are needed in order to introduce a new laparoscope system.…”

Feasibility of single-incision laparoscopic appendectomy in a small hospital

“…An early theoretical concern for single incision laparoscopic surgery was that reduced surgical access and visualization might compromise patient safety [ 15 ]. And early reports suggested that SILA might be associated with a higher incidence of wound infection [ 16 ].…”

“…And early reports suggested that SILA might be associated with a higher incidence of wound infection [ 16 ]. However, as laparoscopic techniques and equipment have improved, recent studies have reported that SILA has similar postoperative complication rates to CLA [ 15 17 ]. In a review of randomized trials, Markar et al [ 5 ] found no significant difference between CLA and SILA not only in the overall incidence of surgical complications, but also in the incidence of wound infection, intra-abdominal collection, and ileus.…”

“…Cases of complicated appendicitis were excluded from early studies of SILA because the safety of this procedure was not proven due to technical difficulties [ 18 19 20 21 ]. However, SILA has been performed for cases of complicated appendicitis in recent studies, and complication rates for SILA have not been found to be significantly greater compared to CLA [ 7 8 10 22 ]. Kang et al [ 22 ] suggested that SILA may be performed for cases of complicated appendicitis because an additional trocar can be used if needed.…”

“…To date, there have been several randomized clinical trials comparing outcomes for SILA and CLA [ 7 8 9 ]. However, a consensus regarding the objective benefits of SILA has not been reached [ 10 ]. Furthermore, previously published randomized clinical trials comparing these procedures were conducted in general hospitals with large numbers of patients and excellent surgical environments [ 6 ].…”