Ann Surg Treat Res.  2016 Aug;91(2):74-79. 10.4174/astr.2016.91.2.74.

Feasibility of single-incision laparoscopic appendectomy in a small hospital

• Kang BH
• Yoon KC
• Jung SW
• Lee GR
• Lee HS

• KMID: 2344498
• DOI: http://doi.org/10.4174/astr.2016.91.2.74

Abstract

PURPOSE
This study aimed to compare clinical outcomes for single-incision laparoscopic appendectomy (SILA) and conventional laparoscopic appendectomy (CLA) for the treatment of acute appendicitis and to assess the feasibility of performing SILA in a small hospital with limited surgical instruments and staff experience.
METHODS
Retrospective record review identified 133 patients who underwent laparoscopic appendectomy from December 2013 to April 2015. Patients were categorized according to the type of appendectomy performed (SILA or CLA). Patient characteristics and surgical outcomes were compared between the 2 groups. Postoperative complication rates were compared using the Clavien-Dindo classification. Postoperative pain was assessed using a visual analog scale immediately postsurgery; at 12, 24, 36, and 48 hours postoperatively, and at 7 days postoperatively.
RESULTS
Record review identified 38 patients who had undergone SILA and 95 patients who had undergone CLA. No significant differences in clinical characteristics were found between the 2 groups. There were no significant differences in operation time, time to flatus, or length of hospital stay. Overall complication rates were not significantly different between the 2 groups. No complications worse than grade IIIa occurred in the SILA group. Postoperative pain scores were not significantly different between the 2 groups at any time point.
CONCLUSION
We found comparable surgical outcomes for SILA compared to CLA. Even in a small hospital with limited surgical instruments and staff experience, SILA may be a feasible and safe technique.

Keyword

Appendectomy; Laparoscopy; Minimally invasive surgical procedures

MeSH Terms

Appendectomy*
Appendicitis
Classification
Flatulence
Humans
Laparoscopy
Length of Stay
Minimally Invasive Surgical Procedures
Pain, Postoperative
Postoperative Complications
Retrospective Studies
Surgical Instruments
Visual Analog Scale

Figure

• 

  Fig. 1 Single-incision laparoscopic port. (A) The port is composed of one 5-mm and two 12-mm trocar channels. (B) The umbilical wound of single-incision laparoscopic appendectomy at immediate postoperative time.

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  Fig. 2 Change of visual analog scale (VAS) pain score according to type of surgery. Values are presented as mean ± standard deviation. SILA, single-incision laparoscopic appendectomy; CLA, conventional laparoscopic appendectomy.

Reference

1. Guller U, Hervey S, Purves H, Muhlbaier LH, Peterson ED, Eubanks S, et al. Laparoscopic versus open appendectomy: outcomes comparison based on a large administrative database. Ann Surg. 2004; 39:43–52.

2. Wei B, Qi CL, Chen TF, Zheng ZH, Huang JL, Hu BG, et al. Laparoscopic versus open appendectomy for acute appendicitis: a metaanalysis. Surg Endosc. 2011; 25:1199–1208.

3. Tiwari MM, Reynoso JF, Tsang AW, Oleynikov D. Comparison of outcomes of laparoscopic and open appendectomy in management of uncomplicated and complicated appendicitis. Ann Surg. 2011; 254:927–932.

4. Lee JM, Jang JY, Lee SH, Shim H, Lee JG. Feasibility of the short hospital stays after laparoscopic appendectomy for uncomplicated appendicitis. Yonsei Med J. 2014; 55:1606–1610.

5. Markar SR, Karthikesalingam A, Di Franco F, Harris AM. Systematic review and meta-analysis of single-incision versus conventional multiport appendicectomy. Br J Surg. 2013; 100:1709–1718.

6. Antoniou SA, Koch OO, Antoniou GA, Lasithiotakis K, Chalkiadakis GE, Pointner R, et al. Meta-analysis of randomized trials on single-incision laparoscopic versus conventional laparoscopic appendectomy. Am J Surg. 2014; 207:613–622.

7. Lee WS, Choi ST, Lee JN, Kim KK, Park YH, Lee WK, et al. Single-port laparoscopic appendectomy versus conventional laparoscopic appendectomy: a prospective randomized controlled study. Ann Surg. 2013; 257:214–218.

8. Frutos MD, Abrisqueta J, Lujan J, Abellan I, Parrilla P. Randomized prospective study to compare laparoscopic appendectomy versus umbilical single-incision appendectomy. Ann Surg. 2013; 257:413–418.

9. Carter JT, Kaplan JA, Nguyen JN, Lin MY, Rogers SJ, Harris HW. A prospective, randomized controlled trial of single-incision laparoscopic vs conventional 3-port laparoscopic appendectomy for treatment of acute appendicitis. J Am Coll Surg. 2014; 218:950–959.

10. SCARLESS Study Group. Ahmed I, Cook JA, Duncan A, Krukowski ZH, Malik M, et al. Single port/incision laparoscopic surgery compared with standard three-port laparoscopic surgery for appendicectomy: a randomized controlled trial. Surg Endosc. 2015; 29:77–85.

11. Lee JS, Choi YI, Lim SH, Hong TH. Transumbilical single port laparoscopic appendectomy using basic equipment: a comparison with the three ports method. J Korean Surg Soc. 2012; 83:212–217.

12. Katkhouda N, Mason RJ, Towfigh S, Gevorgyan A, Essani R. Laparoscopic versus open appendectomy: a prospective randomized double-blind study. Ann Surg. 2005; 242:439–448.

13. Sabiston DC, Townsend CM. Sabiston textbook of surgery: the biological basis of modern surgical practice. 19th ed. Philadelphia (PA): Elsevier Saunders;2012.

14. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009; 250:187–196.

15. SCARLESS Study Group. Ahmed I, Cook JA, Duncan A, Krukowski ZH, Malik M, MacLennan G, et al. Single port incision laparoscopic surgery compared with standard three-port laparoscopic sugery for appendicectomy: a randomized controlled trial. Surg Endosc. 2015; 29:77–85.

16. Teoh AY, Chiu PW, Wong TC, Wong SK, Lai PB, Ng EK. A case-controlled comparison of single-site access versus conventional three-port laparoscopic appendectomy. Surg Endosc. 2011; 25:1415–1419.

17. Xu AM, Huang L, Li TJ. Single-incision versus three-port laparoscopic appendectomy for acute appendicitis: systematic review and meta-analysis of randomized controlled trials. Surg Endosc. 2015; 29:822–843.

18. St Peter SD, Adibe OO, Juang D, Sharp SW, Garey CL, Laituri CA, et al. Single incision versus standard 3-port laparoscopic appendectomy: a prospective randomized trial. Ann Surg. 2011; 254:586–590.

19. Kim HO, Yoo CH, Lee SR, Son BH, Park YL, Shin JH, et al. Pain after laparoscopic appendectomy: a comparison of transumbilical single-port and conventional laparoscopic surgery. J Korean Surg Soc. 2012; 82:172–178.

20. Teoh AY, Chiu PW, Wong TC, Poon MC, Wong SK, Leong HT, et al. A double-blinded randomized controlled trial of laparoendoscopic single-site access versus conventional 3-port appendectomy. Ann Surg. 2012; 256:909–914.

21. Baik SM, Hong KS, Kim YI. A comparison of transumbilical single-port laparoscopic appendectomy and conventional three-port laparoscopic appendectomy: from the diagnosis to the hospital cost. J Korean Surg Soc. 2013; 85:68–74.

22. Kang KC, Lee SY, Kang DB, Kim SH, Oh JT, Choi DH, et al. Application of single incision laparoscopic surgery for appendectomies in patients with complicated appendicitis. J Korean Soc Coloproctol. 2010; 26:388–394.

23. Buckley FP 3rd, Vassaur H, Monsivais S, Jupiter D, Watson R, Eckford J. Single-incision laparoscopic appendectomy versus traditional three-port laparoscopic appendectomy: an analysis of outcomes at a single institution. Surg Endosc. 2014; 28:626–630.

24. Sozutek A, Colak T, Dirlik M, Ocal K, Turkmenoglu O, Dag A. A prospective randomized comparison of single-port laparoscopic procedure with open and standard 3-port laparoscopic procedures in the treatment of acute appendicitis. Surg Laparosc Endosc Percutan Tech. 2013; 23:74–78.