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Liu F, Lv Q, Wang CY, Li ZW, Liu XR, Peng D. Single-port laparoscopic appendectomy using new surgical procedure versus conventional three-port laparoscopic appendectomy. Updates Surg 2024; 76:1347-1355. [PMID: 38441852 DOI: 10.1007/s13304-024-01775-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 01/29/2024] [Indexed: 08/24/2024]
Abstract
The aim of this study was to compare the clinic outcomes between new single-port laparoscopic appendectomy (NSLA) and conventional three-port laparoscopic appendectomy (CTLA) for patients with acute appendicitis. Patients who were diagnosed with acute appendicitis and underwent appendectomy were retrospectively collected from a single clinical center from September 2021 to June 2023. Baseline characteristics, surgical information, and postoperative information were compared between the NSLA group and the CTLA group. Univariate and multivariate logistic regression analyses were used to find out the predictors of overall complications. A total of 296 patients were enrolled from a single clinical medical center. There were 146 (49.3%) males and 150 (50.7%) females. There were 54 (18.2%) patients in the NSLA group and 242 (81.8%) patients in the CTLA group. After data analysis, we found the patients in the NSLA group had a shorter postoperative hospital stay (P < 0.01) than the CTLA group. The other outcomes including intraoperative blood loss (P = 0.167), operation time (P = 0.282), nature of the appendix (P = 0.971), and overall complications (P = 0.543) were not statistically different. After univariate and multivariate logistic regression analysis, we found that age (P = 0.018, OR = 1.039, 95% CI = 1.007-1.072), neutrophil percentage (P = 0.018, OR = 1.070, 95% CI = 1.011-1.132), and fever (P = 0.019, OR = 6.112, 95% CI = 1.340-27.886) were the predictors of overall complications. However, the surgical procedure (NSLA versus CTLA) was not a predictor of overall complications (P = 0.376, OR = 1.964, 95% CI = 0.440-8.768). Compared with CTLA, there was no significant increase in postoperative overall complications with NSLA, making it a safe and feasible new surgical procedure. More studies are needed to evaluate the long-term results.
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Affiliation(s)
- Fei Liu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Quan Lv
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Chun-Yi Wang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Zi-Wei Li
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Xu-Rui Liu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Dong Peng
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
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Chen S, Zhang G, Hua K, Ding J. Single-port laparoscopy versus conventional laparoscopy of benign adnexal masses during pregnancy: a retrospective case-control study. J Int Med Res 2022; 50:3000605221128153. [PMID: 36314266 PMCID: PMC9623375 DOI: 10.1177/03000605221128153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To compare operative outcomes between single-port laparoscopy (SPL) and conventional laparoscopy (CL) to remove adnexal masses during pregnancy. METHODS This retrospective case-control study included all patients who had undergone laparoscopic removal of benign adnexal masses during pregnancy between October 2010 and January 2020. Multiple clinical characteristics and operative outcomes were retrospectively analysed and compared between patients who had undergone SPL versus CL, including cosmetic satisfaction with the scar, measured on a 10-point scale (10 indicating very satisfied). RESULTS A total of 64 patients were included (SPL, n = 22; and CL, n = 42). Overall scar satisfaction scores significantly favoured SPL versus CL (9.1 ± 1.7 versus 8.1 ± 1.3, respectively), however, surgery duration was significantly longer for SPL than CL (69.2 ± 21.0 min versus 54.7 ± 20.7 min). No incisional hernia was detected in the study. Operative blood loss, decrease in estimated haemoglobin level, length of hospital stay, and hospitalization expenses were comparable between the two groups. Pregnancy and fetal outcomes were not remarkably different. CONCLUSION For removal of benign adnexal masses during pregnancy, SPL may offer superior cosmetic satisfaction versus CL, and was not associated with additional perioperative danger, economic burden, or adverse pregnancy and neonatal outcomes.
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Affiliation(s)
- Sishi Chen
- Department of Gynaecology, the Obstetrics and Gynaecology Hospital of Fudan
University, Shanghai, China,Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases,
Shanghai, China
| | - Ganrong Zhang
- Department of Gynaecology, the Obstetrics and Gynaecology Hospital of Fudan
University, Shanghai, China,Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases,
Shanghai, China
| | - Keqin Hua
- Department of Gynaecology, the Obstetrics and Gynaecology Hospital of Fudan
University, Shanghai, China,Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases,
Shanghai, China,Ke-Qin Hua, Department of Gynaecology, the Obstetrics
and Gynaecology Hospital of Fudan University, 128 Shenyang Road, Shanghai 200090, China.
| | - Jingxin Ding
- Department of Gynaecology, the Obstetrics and Gynaecology Hospital of Fudan
University, Shanghai, China,Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases,
Shanghai, China,Jing-Xin Ding, Department of Gynaecology, the
Obstetrics and Gynaecology Hospital of Fudan University, 128 Shenyang Road, Shanghai 200090,
China.
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Lee GR, Kim JH, Kim CH, Lee YS, Kim JJ. Single-incision laparoscopic appendectomy is a safe procedure for beginners to perform: experience from 1948 cases. Surg Endosc 2020; 35:2997-3002. [PMID: 32548655 DOI: 10.1007/s00464-020-07744-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 06/12/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Single-incision laparoscopic appendectomy (SIL-A) has recently become an option for treating appendicitis. The aim of this study was to evaluate the safety, feasibility, and surgical outcomes of SIL-A by residents and surgeons during the learning period. METHODS A total of 1948 consecutive patients who underwent SIL-A from May 2008 to November 2014 were studied retrospectively. Surgeries were performed by residents and eight surgeons. Prior to the first case, surgeons and residents had been trained in a training protocol during the learning period. Three initial cases of SIL-A were performed under the supervision of experienced surgeons. Patients were divided into two groups: group 1 (learning period, n = 483), the first 40 cases by each surgeon and resident; and group 2 (experienced period, n = 1465), cases after the 40th procedure performed by each surgeon. Surgical results were compared between the two groups by performing propensity score matching analysis. RESULTS After propensity score matching, there was no significant difference in patient demographics and characteristics of appendicitis between the two groups. The operating time was longer in group 1 than in group 2 (45.3 ± 18.0 vs. 33.9 ± 16.1 min, p < 0.001). The morbidity rate (7.0% vs. 6.5%, p = 0.795) was similar between the two groups. Readmission rate (2.1% vs. 1.3%, p = 0.414) and reoperation rate (0.8% vs. 0.8%, p = 0.348) were also similar between the two groups. However, the rate of incisional hernia occurrence (0.6% vs. 0%, p = 0.066) tended to be larger in group 1 than in group 2 without showing a significant difference. CONCLUSION SIL-A is a technically feasible and safe procedure when it is performed by residents and surgeons during learning period under an appropriate training protocol. However, residents and surgeons in the learning period should perform it carefully to prevent incisional hernias.
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Affiliation(s)
- Gyeo Ra Lee
- Department of Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, #665, Bupyung-6-dong, Bupyunggu, 403-720, Incheon, Korea
| | - Ji Hoon Kim
- Department of Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, #665, Bupyung-6-dong, Bupyunggu, 403-720, Incheon, Korea.
| | - Chang Hyun Kim
- Department of Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, #665, Bupyung-6-dong, Bupyunggu, 403-720, Incheon, Korea
| | - Yoon Suk Lee
- Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Korea
| | - Jin Jo Kim
- Department of Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, #665, Bupyung-6-dong, Bupyunggu, 403-720, Incheon, Korea
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Risk factors for additional port insertion in single-port laparoscopic appendectomy. Wideochir Inne Tech Maloinwazyjne 2019; 14:223-228. [PMID: 31118987 PMCID: PMC6528115 DOI: 10.5114/wiitm.2018.77714] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 08/06/2018] [Indexed: 11/24/2022] Open
Abstract
Introduction Single-port laparoscopic appendectomy (SPLA) was expected to have reduced risk of wound infection, less postoperative pain, and improved patient’s satisfaction with better cosmesis compared with conventional laparoscopic appendectomy (CLA). When SPLA is converted to CLA, the additional incision for another port insertion can lead to a decrease in the surgical advantages and clinical benefit. Aim To evaluate risk factors for conversion to CLA during SPLA. Material and methods Between August 2015 and December 2016, patients who underwent intended SPLA were retrospectively reviewed. Conversion was defined as any insertion of an additional port, and complicated appendicitis was defined as gangrenous or perforated appendicitis, abscess, or peritonitis in preoperative computed tomography. Postoperative complication was defined as any deviation in the routine postoperative course within 30 days postoperatively. Results Of 409 patients, 65 (15.9%) were treated with additional port insertion. The overall complication rate was 1.5% in each group, of which 1 patient developed superficial SSI and 4 patients developed deep surgical site infections in the SPLA group. After univariable and multivariable analysis, old age, male sex, increased serum C-reactive protein (OR = 2.944; 95% CI: 1.433–6.047; p = 0.003), and complicated appendicitis (OR = 3.330; 95% CI: 1.304–8.503; p = 0.012) were significant risk factors for conversion to CLA. Conclusions The conversion rate to CLA was 15.9%. Serum C-reactive protein level and complicated appendicitis were strong predictive factors for conversion from SPLA in acute appendicitis.
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Teoh AYB, Chan SM, Yip HC, Wong VWY, Chiu PWY, Ng EKW. Randomized controlled trial of EndoWrist-enabled robotic versus human laparoendoscopic single-site access surgery (LESS) in the porcine model. Surg Endosc 2017; 32:1273-1279. [PMID: 28801710 DOI: 10.1007/s00464-017-5803-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 07/28/2017] [Indexed: 12/14/2022]
Abstract
INTRODUCTION A robotic laparoendoscopic single-site access surgery (R-LESS) platform that incorporates the EndoWrist function of robotic instruments may provide better triangulation and retraction during LESS. The aim of the study is to assess if R-LESS is feasible with standard robotic instruments via a single incision and whether the approach could reduce the difficulty of the procedure and confer additional benefits over conventional LESS. METHODS This was a prospective randomized controlled study investigating the workload performance, efficacy, and risks of performing R-LESS when compared with human LESS (H-LESS) in a survival porcine model for cholecystectomy and gastrojejunostomy. The primary outcome is the NASA task load index. Secondary outcomes included the difficulty of the procedures, procedural time, morbidities, and mortalities. RESULTS Twenty-four cholecystectomies and gastrojejunostomies using the R-LESS or H-LESS approach (12:12) were performed. None of the swine suffered from procedural adverse events and none of the procedures required conversion. In both the cholecystectomy and gastrojejunostomy groups, R-LESS was associated with significantly lower NASA task load index (P < 0.001) and reduced difficulties in various steps of the procedures. No differences in the overall procedure times of the two procedures were observed (P = 0.315). CONCLUSION The R-LESS approach significantly reduced the workload and difficulties of LESS cholecystectomies and gastrojejunostomies. A dedicated single-site platform that could reduce instrument clashing while retaining the EndoWrist function is eagerly awaited.
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Affiliation(s)
- Anthony Yuen Bun Teoh
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.
| | - Shannon Melissa Chan
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Hon Chi Yip
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Vivien Wai Yin Wong
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Philip Wai Yan Chiu
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Enders Kwok Wai Ng
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
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Lee SM, Park DJ, Yoon JH, Tae SY, Yang SS, Im YC. Evaluating the Feasibility of Single Incision Laparoscopic Appendectomy Performed by a Resident Based on Propensity Score Matching. J Laparoendosc Adv Surg Tech A 2017; 27:1031-1037. [PMID: 28409666 DOI: 10.1089/lap.2017.0016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
PURPOSE Conventional laparoscopic appendectomy (CLA) has been considered the standard for the treatment of acute appendicitis. Recently, single incision laparoscopic appendectomy (SILA) has become an alternative option. There are few reports on the results of SILA performed by residents during the training period. The present study, we report our residents' experience. MATERIALS AND METHODS We reviewed clinical characteristics and outcomes of 1005 patients who underwent appendectomy between October 2013 and April 2016. Every operation was performed by only residents. Clinical characteristics and operative outcomes between SILA and CLA group were reviewed after propensity score matching. RESULTS SILA was used more frequently in younger patients (23.3 versus 36.4 years, P = .000), women (66.4% versus 45.9%, P = .000), and patients with lower body mass index (20.2 versus 22.9 kg/m2, P = .043). After propensity score matching, the rate of complicated appendicitis was lower (12.9% versus 15.5%, P = .573), and the mean operative time was slightly shorter in the SILA group than in the CLA group (56.68 versus 59.09 minutes, P = .068), although these differences were not statistically significant. There were no significant differences between the two groups in hospitalization period (2.7 versus 2.9 days, P = .380), the use of analgesics (2.0 versus 2.1 times, P = .128), and wound complication rate (10.3% versus 14.6%, P = .333). CONCLUSION It is a safe and relatively easy procedure with an acceptable postoperative cosmetic outcome that can be incorporated into the routine surgical training.
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Affiliation(s)
- Sung Min Lee
- 1 Department of Surgery, Ulsan University Hospital , Ulsan, Korea
| | - Dong Jin Park
- 1 Department of Surgery, Ulsan University Hospital , Ulsan, Korea.,2 Department of Surgery, University of Ulsan College of Medicine , Ulsan, Korea
| | - Jong Hee Yoon
- 1 Department of Surgery, Ulsan University Hospital , Ulsan, Korea.,2 Department of Surgery, University of Ulsan College of Medicine , Ulsan, Korea
| | - Soon Young Tae
- 1 Department of Surgery, Ulsan University Hospital , Ulsan, Korea.,2 Department of Surgery, University of Ulsan College of Medicine , Ulsan, Korea
| | - Song Soo Yang
- 1 Department of Surgery, Ulsan University Hospital , Ulsan, Korea.,2 Department of Surgery, University of Ulsan College of Medicine , Ulsan, Korea
| | - Yeong Cheol Im
- 1 Department of Surgery, Ulsan University Hospital , Ulsan, Korea.,2 Department of Surgery, University of Ulsan College of Medicine , Ulsan, Korea
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Slater BJ, Rothenberg SS. Two-Site Appendectomy in Children: Description of Technique and Outcomes. J Laparoendosc Adv Surg Tech A 2017; 27:438-440. [PMID: 28099058 DOI: 10.1089/lap.2016.0243] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Kang BH, Yoon KC, Jung SW, Lee GR, Lee HS. Feasibility of single-incision laparoscopic appendectomy in a small hospital. Ann Surg Treat Res 2016; 91:74-9. [PMID: 27478812 PMCID: PMC4961889 DOI: 10.4174/astr.2016.91.2.74] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 06/09/2016] [Accepted: 06/09/2016] [Indexed: 11/30/2022] Open
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.
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Affiliation(s)
- Byung Hee Kang
- Department of Surgery, Armed Forces Ildong Hospital, Pocheon, Korea
| | - Kyung Chul Yoon
- Department of Surgery, Armed Forces Ildong Hospital, Pocheon, Korea
| | - Sung Woo Jung
- Department of Surgery, Armed Forces Ildong Hospital, Pocheon, Korea
| | - Gyeo Ra Lee
- Department of Surgery, Armed Forces Ildong Hospital, Pocheon, Korea
| | - Hyung Soon Lee
- Department of Surgery, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea
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Kang BM, Hwang JW, Ryu BY. Single-port laparoscopic surgery in acute appendicitis: retrospective comparative analysis for 618 patients. Surg Endosc 2016; 30:4968-4975. [PMID: 26983434 DOI: 10.1007/s00464-016-4840-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 02/23/2016] [Indexed: 10/22/2022]
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Concha JAM, Cartes-Velásquez R, Delgado CM. Single-incision laparoscopic appendectomy versus conventional laparoscopy in adults. A systematic review. Acta Cir Bras 2015; 29:826-31. [PMID: 25517497 DOI: 10.1590/s0102-86502014001900010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 11/21/2014] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To determine the best treatment option for not complicated acute appendicitis (AA) in adult patients, between single incision laparoscopy (SIL) and conventional laparoscopy (CL), measured by morbidity associated with disease. METHODS Systematic review. Articles of adults diagnosed with AA treated by SIL or CL were analyzed. Databases included: MEDLINE, LILACS, IBECS, Web of Science, Scopus and Cochrane, using MeSH terms and free words. The studies were analyzed using the MINCIR methodology. Variables included: conversion rate, morbidity, hospital stay, surgery duration, and methodological quality (MQ) of primary studies. Averages, medians and weighted averages were calculated. RESULTS Thirteen articles were analyzed. For SIL and CL the conversion rate were 3.4% and 0.7 %, the morbidity were 8% and 6.5%, the hospital stay were 2.5 and 2.8 days, the surgery duration were 53.4 and 53.8 minutes, and the MQ were 14.3±6.6 and 16.0±6.9 points, respectively. CONCLUSION With the exception of the conversion rate, there are no differences between single incision laparoscopy and conventional laparoscopy for the treatment of acute appendicitis in adults.
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Wang Y, Xiong W, Lan X, Zhang J, Chen T, Liu H, Li G. Suprapubic single incision laparoscopic appendectomy. J Surg Res 2015; 193:577-582. [PMID: 25179807 DOI: 10.1016/j.jss.2014.07.064] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 07/14/2014] [Accepted: 07/30/2014] [Indexed: 12/15/2022]
Abstract
BACKGROUND The single incision method through the umbilicus is commonly used for laparoscopic appendectomy. To obtain a better cosmetic outcome and less surgical complexity, we have designed a new single-incision laparoscopic appendectomy technique performed above the pubic symphysis. METHODS Between January 2011 and January 2012, patients with uncomplicated acute or chronic appendicitis, excluding those with abscess, perforation, peritonitis, and previous pelvic surgery, underwent this innovative laparoscopic appendectomy. During each operation, a multichannel trocar composed of a small wound protector and a size 6 sterile glove was deployed after a 2 cm transverse incision was made 1-2 cm above the pubic hair area. RESULTS Of the 42 patients, 24 were male and 18 were female. Their mean age was 30 ± 11 y. The mean operative time was 58 ± 11 min, mean time to first flatus postoperatively was 17 ± 8 h, and mean postoperative length of hospital stay was 3 ± 1 d. No complications occurred during surgery. No patient required conversion to either multiport or open appendectomy. Postoperative wound inflammation was observed in one case (2.3%). CONCLUSIONS Our results suggested that suprapubic single-incision laparoscopic appendectomy seems to be safe and feasible for selected patients, in consideration of cosmetic outcomes.
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Affiliation(s)
- Yanan Wang
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Wenjun Xiong
- Guangdong Province Hospital of Chinese Medicine, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiaoliang Lan
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jianming Zhang
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Tao Chen
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Hao Liu
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Guoxin Li
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China.
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Comparison and efficacy of LigaSure and rubber band ligature in closing the inflamed cecal stump in a rat model of acute appendicitis. BIOMED RESEARCH INTERNATIONAL 2015; 2015:260312. [PMID: 25699264 PMCID: PMC4324495 DOI: 10.1155/2015/260312] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 10/17/2014] [Indexed: 02/06/2023]
Abstract
Safety of either LigaSure or rubber band in closing inflamed appendiceal stump in acute appendicitis has been less investigated. In this study, cecal ligation followed by resecting inflamed cecum was performed to mimic appendectomy in a rat model of acute appendicitis. Rats were sacrificed immediately (Group A) and 7 days (Group B) after cecal resection, respectively. The cecal stumps were closed by silk ligature (S), 5 mm LigaSure (L), or rubber band (R). Seven days after cecal resection, the LigaSure (BL) and silk subgroups (BS) had significantly less intra-abdominal adhesion and better laparotomy wound healing than rubber band subgroup (BR). The initial bursting pressure at cecal stump was comparable among the three methods; along with tissue healing process, both BL and BS provided a higher bursting pressure than BR 7 days after appendectomy. BL subgroup had more abundant hydroxyproline deposition than BS and BR subgroup. Furthermore, serum TNF-α in BR group kept persistently increasing along with time after cecal resection. Thus, the finding that LigaSure but not rubber band is safe in sealing off the inflamed cecal stump in rat model of acute appendicitis suggests the possibility of applying LigaSure for appendectomy via single port procedure or natural orifice transluminal endoscopic surgery (NOTES).
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Yao D, Wu S, Li Y, Chen Y, Yu X, Han J. Transumbilical single-incision laparoscopic distal pancreatectomy: preliminary experience and comparison to conventional multi-port laparoscopic surgery. BMC Surg 2014; 14:105. [PMID: 25494969 PMCID: PMC4277826 DOI: 10.1186/1471-2482-14-105] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 11/28/2014] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Single-incision laparoscopic surgery (SILS), which has been demonstrated to be safely applied on kinds of surgeries, may represent an improvement over conventional multi-port laparoscopic surgery. However, there are still few clinical experiences of SILS in pancreatic surgery until now. In this study, we will summarize our experience of transumbilical single-incision laparoscopic distal pancreatectomy (TUSI-LDP), and compare its related parameters with conventional multi-port laparoscopic distal pancreatectomy (C-LDP). METHODS A retrospective analysis was conducted for the patients who underwent C-LDP or TUSI-LDP in our department. The demographic data, operative parameters, and postoperative complications in the two groups were summarized and compared. RESULTS Laparoscopic distal pancreatectomy was performed in a total of 21 cases, among which TUSI-LDP was performed in 14 cases. As far as the demographical results concerned, there were no significant differences between the two groups. The conversion to open surgery was conducted in one case in the TUSI-LDP group because of severe adhesion between pancreatic cyst and surrounding tissues, while in the C-LDP group the only one conversion was for the difficult detection of small lesion. The mean operating time and intraoperative blood loss in TUSI-LDP group was a little shorter (166.4 ± 57.4 versus 202.1 ± 122.5 minutes, p > 0.05, and 157.1 ± 162.4 versus 168.6 ± 157.4 ml, p > 0.05). The postoperative pain and post-operation lengths of hospital stay in the TUSI-LDP group were also less, though there was no significant statistical difference between the two groups. For the post-operation complications, in TUSI-LDP group the pancreatic leakage occurred in only one case, and ceased spontaneously with only a drain for 61 days. There were no other complications including postoperative hemorrhage, venous thrombosis, infections and so on in both groups. CONCLUSION For the experienced laparoscopic surgeons, in selected patients, TUSI-LDP is a feasible technique, with excellent cosmetic effect, less postoperative pain and post-operation lengths of hospital stay. With the experience accumulated, the operating time and intraoperative blood loss of TUSI-LDP could also gradually reduce.
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Affiliation(s)
| | - Shuodong Wu
- Department of General Surgery, Shengjing Hospital, China Medical University, Shenyang 110004, China.
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Raakow J, Liesaus HG, Neuhaus P, Raakow R. Single-incision versus multiport laparoscopic appendectomy: a case-matched comparative analysis. Surg Endosc 2014; 29:1530-6. [PMID: 25294525 DOI: 10.1007/s00464-014-3837-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 08/15/2014] [Indexed: 01/07/2023]
Abstract
BACKGROUND The multiport technique is the gold standard for laparoscopic appendectomy, but the use of single-incision laparoscopy is on the increase. The aim of the present study was to compare case-matched cohorts of patients who had undergone single-incision laparoscopic appendectomy (SILA) with those who had undergone conventional multiport laparoscopic appendectomy (MLA). METHODS In a case-matched analysis, all single-incision laparoscopic appendectomies performed between July 2009 and December 2013 at one institution were reviewed and compared to multiport laparoscopic appendectomies performed during the same period. Patients who had undergone SILA were matched in terms of age, gender, body mass index (BMI), and American Society of Anesthesiologists (ASA) scores with the same number of patients who had undergone MLA. Statistical evaluation included the description and comparison of demographic factors, details of surgery, and histological data. A univariate analysis was performed to assess potential risk factors for morbidity after SILA. RESULTS One hundred and fifty-six patients who had undergone SILA were reviewed, matched, and compared to the same number of patients who had undergone MLA. No significant difference was noted in mean operating times (50.83 vs. 50.61 min for SILA and MLA, respectively; p = 0.924) and the length of hospital stay (3.60 vs. 3.66 days; p = 0.704). No patient in either group required conversion to the open procedure while 6 (3.8 %) SILA patients were converted to multiport laparoscopy. SILA was not associated with significantly higher postoperative morbidity compared to MLA (9.6 % vs. 5.8 %; p = 0.288). Postoperative wound infection rates were higher after SILA (3.2 % vs. 0.6 %), but did not achieve statistical significance (p = 0.214). Statistical analysis revealed no risk factors for developing postoperative complications after the single-incision procedure. CONCLUSION SILA is a technically feasible and safe alternative to conventional MLA. The two procedures did not differ in terms of operating times, length of hospital stay, and postoperative outcomes.
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Affiliation(s)
- Jonas Raakow
- Department of General, Visceral and Transplantation Surgery, Universitätsmedizin Berlin, Charité Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany,
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Single-incision versus three-port laparoscopic appendectomy for acute appendicitis: systematic review and meta-analysis of randomized controlled trials. Surg Endosc 2014; 29:822-43. [PMID: 25106718 DOI: 10.1007/s00464-014-3735-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 07/08/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Three-port laparoscopic appendectomy (TPLA) has been shown superior to open appendectomy for acute appendicitis (AA); alternatively, single-incision laparoscopic appendectomy (SILA) is gaining popularity. The choice between SILA and traditional TPLA remains controversial. This meta-analysis of high-quality randomized controlled trials (RCTs) aims to compare efficacy and safety of SILA with TPLA for AA. METHODS We searched MEDLINE, EMBASE, and the Cochrane Library for RCTs comparing SILA with TPLA. Reference lists of relevant articles and reviews, conference proceedings, and ongoing trial databases were also searched. Primary outcomes were operative time, postoperative complications, hospital duration, and days back to normal activities. Meta-analysis was conducted where possible comparing items using weighted mean differences (WMDs) and relative risks (RRs) according to type of data. Methodological quality was evaluated to assess bias risk. RESULTS A total of 8 distinct RCTs comparing SILA (n = 616) with TPLA (n = 618) published from 2010 to 2013 were identified in our analysis. SILA took longer to conduct than TPLA (43 vs 38, WMD: 5.96, 95 % CI 2.54-9.38, P = 0.0006). Patients undergoing SILA needed more extra trocars addressed during operation (7 % vs 0 %, RR: 12.36, 95 % CI 3.83-39.90, P < 0.0001), but could return to full activities earlier (6 vs 7, WMD: -0.68, 95 % CI -1.10 to -0.26, P = 0.001). However, these differences were not clinically significant. All other parameters were comparable. CONCLUSIONS These results provide level 1a support for the clinical similarity that SILA is basically as feasible, effective and safe as TPLA when dealing with AA, although statistically, SILA takes longer to perform, requires more extra trocars, and benefits patients with faster recovery compared with TPLA. Further RCTs are needed to update our finding with advancement of surgical techniques and skills.
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Ohno Y. Role of the transumbilical laparoscopic-assisted single-channel, single-port procedure in an interval appendectomy for pediatric mass-forming appendicitis: a preliminary retrospective analysis. Asian J Endosc Surg 2014; 7:232-6. [PMID: 24861142 DOI: 10.1111/ases.12111] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 03/06/2014] [Accepted: 04/06/2014] [Indexed: 12/26/2022]
Abstract
INTRODUCTION A transumbilical laparoscopic-assisted single-channel, single-port procedure was introduced during laparoscopic interval appendectomy for mass-forming appendicitis in children. The aim of this study was to evaluate the results of the original laparoscopic interval appendectomy. METHODS This study analyzed 31 children who underwent laparoscopic interval appendectomy using a single-channel, single-port procedure. The appendectomy was usually planned 8-12 weeks following initial conservative treatment. The procedure was a single-channel surgery using a 12-mm single port. Both a 5-mm telescope and grasper were inserted simultaneously into the single channel. The grasper held the appendix, and an extracorporeal appendectomy was performed. RESULTS Appendectomy was planned for 29 patients, as 2 patients deviated from the protocol. The procedure was successful in 21 patients (72.4%). An accessory port was necessary in eight patients, two of whom successfully underwent laparoscopic surgery; the remaining six were converted to open appendectomy. The average length of surgery was 43 min in the single-channel, single-port procedure. No postoperative complications occurred in any patient. CONCLUSION The single-channel, single-port procedure was successfully performed in over 70% of the patients. This preliminary retrospective analysis indicates that the procedure is safe and potentially beneficial in children with mass-forming appendicitis who require laparoscopic interval appendectomy.
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Affiliation(s)
- Yasuharu Ohno
- Department of Surgery, Oita Children's Hospital, Oita, Japan; Department of Pediatric Surgery, Saitama Medical University, Iruma, Japan
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Tayar C, Claude T, Subar D, Daren S, Salloum C, Chady S, Malek A, Alexandre M, Laurent A, Alexis L, Azoulay D, Daniel A. Single incision laparoscopic hepatectomy: Advances in laparoscopic liver surgery. J Minim Access Surg 2014; 10:14-7. [PMID: 24501503 PMCID: PMC3902552 DOI: 10.4103/0972-9941.124454] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2013] [Accepted: 05/27/2013] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND: Laparoscopic liver surgery is now an established practice in many institutions. It is a safe and feasible approach in experienced hands. Single incision laparoscopic surgery (SILS) has been performed for cholecystectomies, nephrectomies, splenectomies and obesity surgery. However, the use of SILS in liver surgery has been rarely reported. We report our initial experience in seven patients on single incision laparoscopic hepatectomy (SILH). PATIENTS AND METHODS: From October 2010 to September 2012, seven patients underwent single-incision laparoscopic liver surgery. The abdomen was approached through a 25 mm periumbilical incision. No supplemental ports were required. The liver was transected using a combination of LigaSure™ (Covidien-Valleylab. Boulder. USA), Harmonic Scalpel and Ligaclips (Ethicon Endo-Surgery, Inc.). RESULTS: Liver resection was successfully completed for the seven patients. The procedures consisted of two partial resections of segment three, two partial resections of segment five and three partial resections of segment six. The mean operative time was 98.3 min (range: 60-150 min) and the mean estimated blood loss was 57 ml (range: 25-150 ml). The postoperative courses were uneventful and the mean hospital stay was 5.1 days (range: 1-13 days). Pathology identified three benign and four malignant liver tumours with clear margins. CONCLUSION: SILH is a technically feasible and safe approach for wedge resections of the liver without oncological compromise and with favourable cosmetic results. This surgical technique requires relatively advanced laparoscopic skills. Further studies are needed to determine the potential advantages of this technique, apart from the better cosmetic result, compared to the conventional laparoscopic approach.
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Affiliation(s)
- Claude Tayar
- Digestive, Hepato-Bilio-Pancreatic Surgical and Hepatic Transplantation Service, Henri Mondor Hospital, Creteil, France
| | - Tayar Claude
- Digestive, Hepato-Bilio-Pancreatic Surgical and Hepatic Transplantation Service, Henri Mondor Hospital, Creteil, France
| | - Daren Subar
- Digestive, Hepato-Bilio-Pancreatic Surgical and Hepatic Transplantation Service, Henri Mondor Hospital, Creteil, France
| | - Subar Daren
- Digestive, Hepato-Bilio-Pancreatic Surgical and Hepatic Transplantation Service, Henri Mondor Hospital, Creteil, France ; Department of General and Hepato-Pancreato-Biliary Surgery, Blackburn Royal Hospital, Blackburn, Lancashire, United Kingdom
| | - Chady Salloum
- Digestive, Hepato-Bilio-Pancreatic Surgical and Hepatic Transplantation Service, Henri Mondor Hospital, Creteil, France
| | - Salloum Chady
- Digestive, Hepato-Bilio-Pancreatic Surgical and Hepatic Transplantation Service, Henri Mondor Hospital, Creteil, France
| | - Alexandre Malek
- Digestive, Hepato-Bilio-Pancreatic Surgical and Hepatic Transplantation Service, Henri Mondor Hospital, Creteil, France
| | - Malek Alexandre
- Digestive, Hepato-Bilio-Pancreatic Surgical and Hepatic Transplantation Service, Henri Mondor Hospital, Creteil, France
| | - Alexis Laurent
- Digestive, Hepato-Bilio-Pancreatic Surgical and Hepatic Transplantation Service, Henri Mondor Hospital, Creteil, France
| | - Laurent Alexis
- Digestive, Hepato-Bilio-Pancreatic Surgical and Hepatic Transplantation Service, Henri Mondor Hospital, Creteil, France
| | - Daniel Azoulay
- Digestive, Hepato-Bilio-Pancreatic Surgical and Hepatic Transplantation Service, Henri Mondor Hospital, Creteil, France
| | - Azoulay Daniel
- Digestive, Hepato-Bilio-Pancreatic Surgical and Hepatic Transplantation Service, Henri Mondor Hospital, Creteil, France
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Hua J, Gong J, Xu B, Yang T, Song Z. Single-incision versus conventional laparoscopic appendectomy: a meta-analysis of randomized controlled trials. J Gastrointest Surg 2014; 18:426-36. [PMID: 24002764 DOI: 10.1007/s11605-013-2328-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 08/19/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND Single-incision laparoscopic appendectomy (SILA) has gained enormous popularity worldwide. We conducted a meta-analysis to assess feasibility, safety, and benefits of SILA as compared with conventional laparoscopic appendectomy (CLA). METHODS A literature search in MEDLINE, EMBASE, and Cochrane Library was performed to identify eligible randomized controlled trials (RCTs). Primary outcome measures were total postoperative complications, wound infection, intra-abdominal abscess, and ileus. Secondary outcome measures were operative time, length of hospital stay, pain scores, conversion rate, reoperation rate, and time to return to normal activity. RESULTS Eight RCTs, totaling 1,211 patients (604 for SILA and 607 for CLA), met the inclusion criteria. The incidences of total postoperative complications, wound infection, intra-abdominal abscess, and ileus were statistically similar between the SILA and CLA groups. Compared with CLA, SILA was associated with a significantly longer operative time (weighted mean difference = 5.28 min; 95 % confidence interval = 3.61 to 6.94). Time to return to normal activity was shorter in the SILA group (by 0.69 days). Length of hospital stay, pain scores, conversion rate, and reoperation rate were similar between groups. CONCLUSION SILA is feasible and safe with no obvious advantages over CLA. Therefore, it may be considered as an alternative to CLA.
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Affiliation(s)
- Jie Hua
- Department of General Surgery, Shanghai Tenth People's Hospital, Tongji University of Medicine, 301 Yanchang Middle Road, Shanghai, 200072, China
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Jiang X, Meng HB, Zhou DL, Ding WX, Lu LS. Comparison of clinical outcomes of open, laparoscopic and single port appendicectomies. Ann R Coll Surg Engl 2013; 95:468-72. [PMID: 24112490 DOI: 10.1308/003588413x13629960049397] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Appendicectomy is the most common surgical procedure performed in general surgery. This study aimed to compare the outcomes of open appendicectomy (OA), laparoscopic appendicectomy (LA) and single port laparoscopic appendicectomy (SPLA). METHODS Fifty consecutive patients with suspected acute appendicitis were studied (OA: n=20, LA: n=20, SPLA: n=10). Clinical outcomes were compared between the three groups in terms of operative time, blood loss, postoperative complications, length of hospital stay and cost. RESULTS Patient demographics were similar among groups (p>0.05). SPLA was characterised by longer operative time (88.1 minutes vs 35.6 minutes in OA and 33.4 minutes in LA) and higher costs (12.84 thousand Chinese yuan [RMB] vs 8.41 thousand RMB in LA and 4.99 thousand RMB in OA). OA was characterised by more blood loss (9.8ml vs 7.5ml in SPLA and 6.8ml in LA), longer hospital stay (7.5 days vs 3.5 days in LA and 3.4 days in SPLA) and lower costs. The total number of complications was higher for OA (n=2) than for LA and SPLA (n=0) although this was not statistically significant. CONCLUSIONS Where feasible, LA should be undertaken as the initial treatment of choice for most cases of suspected appendicitis.
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Affiliation(s)
- X Jiang
- Shanghai 10th People's Hospital, China
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21
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Kim JH, Lee YS, Kim JJ, Park SM. Single port laparoscopic totally extraperitoneal hernioplasty: a comparative study of short-term outcome with conventional laparoscopic totally extraperitoneal hernioplasty. World J Surg 2013; 37:746-51. [PMID: 23358595 DOI: 10.1007/s00268-013-1925-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Recently, single port laparoscopic surgery has begun to develop as an extension of minimally invasive surgery, but there have been only a few reports of single port laparoscopic totally extraperitoneal (SPLTEP) hernioplasty. In addition, there are few comparative studies with conventional laparoscopic totally extraperitoneal (CLTEP) hernioplasty. The aim of the present study was to report our experience with SPLTEP hernioplasty and to compare short-term outcomes for SPLTEP hernioplasty with CLTEP hernioplasty. METHODS Data were prospectively collected for all patients undergoing SPLTEP hernioplasty for inguinal hernia at Incheon St. Mary's Hospital, Incheon, Korea. Data for the SPLTEP group (n = 76 patients enrolled between June 2010 and May 2011) were compared retrospectively with data for the CLTEP group (n = 93 patients enrolled between June 2009 and May 2010). RESULTS There were no significant differences in patient demographics. This study showed no significant difference in terms of operative time between the two groups (SPLTEP group 54.0 min vs. CLTEP group 47.8 min; p = 0.07). There were no conversions to conventional TEP hernioplasty or transabdominal preperitoneal hernioplasty or open surgery in SPLTEP hernioplasty. Morbidity rates were 7.9 % (n = 6) in the SPLTEP group and 10.8 % (n = 10) in the CLTEP group, and the difference was not significant. CONCLUSIONS Single port laparoscopic totally extraperitoneal hernioplasty is technically feasible and the short-term operative outcome is comparable to that of CLTEP hernioplasty. Future large-scale prospective controlled studies and long-term analysis are needed to establish the cosmetic outcomes, quality of life, long-term recurrence rate, and long-term complication rate of SPLTEP hernioplasty.
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Affiliation(s)
- Ji Hoon Kim
- Department of Surgery, Incheon St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
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Li P, Chen ZH, Li QG, Qiao T, Tian YY, Wang DR. Safety and efficacy of single-incision laparoscopic surgery for appendectomies: A meta-analysis. World J Gastroenterol 2013; 19:4072-4082. [PMID: 23840155 PMCID: PMC3703197 DOI: 10.3748/wjg.v19.i25.4072] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Revised: 03/20/2013] [Accepted: 05/08/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To compare single incision laparoscopic surgery for an appendectomy (SILS-A) with conventional laparoscopic appendectomy (C-LA) when implemented by experienced surgeons.
METHODS: Studies and relevant literature regarding the performance of single-incision laparoscopic surgery vs conventional laparoscopic surgery for appendectomy were searched for in the Cochrane Central Register of Controlled Clinical Trials, MEDLINE, EMBASE and World Health Organization international trial register. The operation time (OR time), complications, wound infection and postoperative day using SILS-A or C-LA were pooled and compared using a meta-analysis. The risk ratios and mean differences were calculated with 95%CIs to evaluate the effect of SILS-A.
RESULTS: Sixteen recent studies including 1624 patients were included in this meta-analysis. These studies demonstrated that, compared with C-LA, SILS-A has a similar OR time in adults but needs a longer OR time in children. SILS-A has similar complications, wound infection and length of the postoperative day in adults and children, and required similar doses of narcotics in children, the pooled mean different of -0.14 [95%CI: -2.73-(-2.45), P > 0.05], the pooled mean different of 11.47 (95%CI: 10.84-12.09, P < 0.001), a pooled RR of 1.15 (95%CI: 0.72-1.83, P > 0.05), a pooled RR of 1.9 (95%CI: 0.92-3.91, P > 0.05), a pooled RR of 1.01 (95%CI: 0.51-2.0, P > 0.05) a pooled RR of 1.86 (95%CI: 0.77-4.48, P > 0.05), the pooled mean different of -0.25 (95%CI: -0.50-0, P = 0.05) the pooled mean different of -0.01 (95%CI: -0.05-0.04, P > 0.05) the pooled mean different of -0.13 (95%CI: -0.49-0.23, P > 0.05) respectively.
CONCLUSION: SILS-A is a technically feasible and reliable approach with short-term results similar to those obtained with the C-LA procedure.
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Single-incision versus conventional three-incision laparoscopic appendicectomy for appendicitis: a systematic review and meta-analysis. J Pediatr Surg 2013; 48:1088-98. [PMID: 23701788 DOI: 10.1016/j.jpedsurg.2013.01.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Revised: 01/17/2013] [Accepted: 01/19/2013] [Indexed: 12/15/2022]
Abstract
BACKGROUND This meta-analysis was designed to investigate the safety and efficacy of single-incision laparoscopic appendicectomy (SILA) and three-incision laparoscopic appendicectomy (TILA) in the treatment of appendicitis. MATERIALS AND METHODS Studies published since 1992 that compared SILA versus TILA in laparoscopic appendicectomy were collected. Data on operative parameters, postoperative recovery, postoperative pain and complications, and hospitalization costs for SILA and TILA were meta-analyzed using fixed-effect and random-effect models. RESULTS Seventeen studies (1 randomized controlled trial and 16 retrospective studies) that included 1809 patients were studied. Of these patients, 793 and 1016 had undergone SILA and TILA, respectively. There was significantly shorter length of hospital stay; however, there were evidently higher conversion rate, and perhaps higher surgical difficulty and hospitalization costs for SILA compared with TILA. Other outcome variables such as operative time, blood loss, time to first oral intake, postoperative pain and complications were not found to be statistically significant for either group. CONCLUSIONS Compared with TILA, SILA has the advantage of shorter hospital stay, and it can achieve comparable operative time, blood loss, postoperative recovery, postoperative pain and complications with TILA. The drawback is that SILA is associated with higher conversion rate, and perhaps higher surgical difficulty and hospitalization costs. Whether it can achieve improvement in cosmesis remains to be confirmed.
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Liao YT, Lin TH, Lee PC, Chou TH, Liang JT, Lin MT. Learning Curve of Single-Port Laparoscopic Appendectomy for Noncomplicated Acute Appendicitis: A Preliminary Analysis Compared with Conventional Laparoscopic Appendectomy. J Laparoendosc Adv Surg Tech A 2013; 23:441-6. [PMID: 23517613 DOI: 10.1089/lap.2012.0265] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Affiliation(s)
- Yu-Tso Liao
- Division of Colorectal Surgery, Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
- Division of General Surgery, Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Tsu-Hsin Lin
- Department of Trauma, National Taiwan University Hospital, Taipei, Taiwan
| | - Po-Chu Lee
- Department of Trauma, National Taiwan University Hospital, Taipei, Taiwan
| | - Tzung-Hsin Chou
- Division of Colorectal Surgery, Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
- Department of Emergency, National Taiwan University Hospital, Taipei, Taiwan
| | - Jin-Tung Liang
- Division of Colorectal Surgery, Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Ming-Tsan Lin
- Division of General Surgery, Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
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Pisanu A, Porceddu G, Reccia I, Saba A, Uccheddu A. Meta-analysis of studies comparing single-incision laparoscopic appendectomy and conventional multiport laparoscopic appendectomy. J Surg Res 2013; 183:e49-59. [PMID: 23582760 DOI: 10.1016/j.jss.2013.03.038] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2012] [Revised: 02/14/2013] [Accepted: 03/13/2013] [Indexed: 12/14/2022]
Abstract
BACKGROUND There is no consensus that single-incision laparoscopic appendectomy (SILS-A) is on a par with conventional multiport laparoscopic appendectomy (CMLA). The aim of this meta-analysis was to assess feasibility, safety, and potential benefits of SILS-A when compared with CMLA. METHODS A literature search for studies comparing SILS-A and CMLA was performed. Studies were reviewed for the outcome of interest: patient characteristics, operative outcome, postoperative recovery, postoperative morbidity, patient satisfaction, and cosmetic results. RESULTS Thirteen studies comparing SILS-A and CMLA were reviewed: two prospective randomized trials, four prospective studies, and seven retrospective studies. Overall, 893 patients were operated on: by SILS-A in 402 cases (45.0%) versus 491 cases (55.0%) by CMLA. Patients in the SILS-A group were significantly younger than those in the CMLA group (31.2 versus 33.5 y). No other differences were found. Patient satisfaction score was impossible to meta-analyze. CONCLUSIONS Appendectomy via SILS-A may be considered as an alternative to CMLA. However, these results must be approached with caution as they are based on data from nonrandomized observational studies. The feasibility and safety of SILS-A must be mainly assessed for difficult clinical situations such as severe obesity, localized abscess, or diffuse peritonitis from a ruptured appendix in the setting of new prospective randomized trials.
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Affiliation(s)
- Adolfo Pisanu
- Department of Surgery, Clinica Chirurgica, University of Cagliari, Monserrato, Italy.
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Randomized prospective study to compare laparoscopic appendectomy versus umbilical single-incision appendectomy. Ann Surg 2013; 257:413-8. [PMID: 23386239 DOI: 10.1097/sla.0b013e318278d225] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION The use of single-incision laparoscopic surgery may represent an improvement over conventional laparoscopic surgery. In recent years, more and more articles have been published demonstrating the feasibility of this approach. Hence, for this reason, we present this randomized prospective study to compare the 2 techniques. METHODS Between September 2009 and December 2010, a total of 184 patients with a diagnosis of acute appendicitis and indicated for surgery were included in the study, of whom, 91 received an appendectomy via a single umbilical incision and 93 via conventional laparoscopy. The study protocol was approved by the ethical committee of the Virgen de la Arrixaca University Hospital (Murcia). The study was registered on ClinicalTrials.gov with inscription number NCT0151529. All the operations were performed by the same team of surgeons. RESULTS As far as the demographical results of the study population are concerned, there were no significant differences between the 2 groups for age, weight, sex, body mass index, and removed appendix type. Operating time was longer with the single-port approach: 38.13 ± 13.49 versus 32.12 ± 12.44 minutes (P = 0.02). Significant differences were observed for postoperative pain, which was measured on the visual analog scale, with less pain reported in the single-incision group: 2.76 ± 1.64 versus 3.78 ± 1.76 (P < 0.001). There were no significant differences between the 2 groups for early and late complications and lengths of hospital stay measured in postoperative hours. CONCLUSIONS The transumbilical single-port approach is seen as a feasible technique for performing appendectomy. It does not increase the rate of complications and represents a possible alternative to conventional laparoscopic appendectomy.
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Kye BH, Lee J, Kim W, Kim D, Lee D. Comparative study between single-incision and three-port laparoscopic appendectomy: a prospective randomized trial. J Laparoendosc Adv Surg Tech A 2013; 23:431-6. [PMID: 23473061 DOI: 10.1089/lap.2012.0284] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Single-incision laparoscopic surgery is a new procedure used to treat a variety of diseases requiring surgical intervention. The aim of this prospective comparative study is to compare the technical feasibility and safety of single-incision and three-port laparoscopic appendectomy. STUDY DESIGN Between February 2009 and April 2010, 102 patients with appendicitis were enrolled in this study. The patients were randomly assigned to two groups: single-incision or three-port laparoscopic appendectomy. Patients with perforated appendicitis were not excluded. We analyzed the patients' clinical characteristics and surgical outcomes. RESULTS There were no significant differences in preoperative patient demographics between the two groups with respect to body mass index (22.03±4.07 kg/m(2) in the single-incision group versus 21.97±3.49 kg/m(2) in the three-port group, P=.930). The pain score on the visual analog scale on postoperative Day 1 was significantly lower in the single-incision group than in the three-port group (3.22±1.22 versus 3.90±1.46, P=.012). Additionally, recovery time to daily life was significantly shorter in the single-incision group than in the three-port group (3.22±1.04 versus 3.94±1.43 days, P=.005). In patients with perforated appendicitis, the single-incision procedure took approximately 10 minutes less than the three-port procedure (44.11±7.75 versus 54.14±32.21 minutes, P=.449), and the postoperative hospital stay (P=.033) and recovery time to daily life (P=.001) were significantly shorter in the single-incision group. CONCLUSIONS Single-incision laparoscopic appendectomy is a feasible and safe procedure, even in patients with perforated appendicitis, and this procedure is even less invasive than three-port laparoscopic surgical techniques.
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Affiliation(s)
- Bong-Hyeon Kye
- Department of Surgery, School of Medicine, The Catholic University of Korea, Seoul, Korea
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A double-blinded randomized controlled trial of laparoendoscopic single-site access versus conventional 3-port appendectomy. Ann Surg 2013; 256:909-14. [PMID: 23154391 DOI: 10.1097/sla.0b013e3182765fcf] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The aim of the current study was to perform a multicentered prospective double-blinded randomized controlled trial comparing laparoendoscopic single-site access (LESS) versus conventional three-port laparoscopic appendectomy (TPLA). BACKGROUND The clinical benefits and disadvantages of LESS appendectomy are uncertain. METHODS Between October 2009 and March 2011, consecutive patients admitted with clinical or radiological evidence of appendicitis were randomly assigned to receive either LESS or TPLA. The main outcome measurement was overall pain score. Secondary outcome measurements included operative time, conversion rates, morbidity rates, activity pain scores, activity scores, patient satisfaction, and cosmesis scores. RESULTS During the study period, 200 patients were recruited to the study. There were no significant differences in the morbidity rates, operative time, conversion rates, and postoperative recovery. There were also no differences in the overall pain score and pain score at rest. However, patients in the LESS group experienced significantly more pain upon coughing or standing and required more intravenous analgesics (P = 0.001, 0.038, and 0.035, respectively). Wound cosmesis and satisfaction scores on the contrary were better in the LESS group (P = 0.002 and P = 0.052). No differences in the quality-of-life assessments were present at 2 weeks after operation. CONCLUSIONS LESS and conventional appendectomy resulted in similar perioperative outcomes. However, LESS appendectomy resulted in worst pain scores upon exertion and required a higher dosage of intravenous analgesics when compared with TPLA. On the contrary, wound cosmesis and satisfaction scores were better in the LESS group. Hence, adoption of the technique for appendectomy will depend on patient preferences and the presence of local expertise.
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Kang J, Bae BN, Gwak G, Park I, Cho H, Yang K, Kim KW, Han S, Kim HJ, Kim YD. Comparative study of a single-incision laparoscopic and a conventional laparoscopic appendectomy for the treatment of acute appendicitis. JOURNAL OF THE KOREAN SOCIETY OF COLOPROCTOLOGY 2012; 28:304-8. [PMID: 23346509 PMCID: PMC3548145 DOI: 10.3393/jksc.2012.28.6.304] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2012] [Accepted: 10/29/2012] [Indexed: 02/08/2023]
Abstract
Purpose For the treatment of acute appendicitis, a conventional laparoscopic appendectomy (LA) has been widely performed. Recently, the use of single incision laparoscopic surgery (SILS) is increasing because it is believed to have advantages over conventional laparoscopic surgery. In this study, we compared SILS and a conventional LA. Methods We analyzed the 217 patients who received laparoscopy-assisted appendectomies between August 2010 and April 2012 at Inje University Sanggye Paik Hospital. One hundred-twelve patients underwent SILS, and 105 patients underwent LA. For the two groups, we compared the operation times, postoperative laboratory results, postoperative pain, hospital stay, and postoperative complications. Results The patients' demographics, including body mass index, were not significantly different between the two groups. There were 6 perforated appendicitis cases in the SILS group and 5 cases in the LA group. The mean operative time in the SILS group was 65.88 ± 22.74 minutes whereas that in the LA group was 61.70 ± 22.27 minutes (P = 0.276). There were no significant differences in the mean hospital stays, use of nonsteroidal antiinflammatory drugs, and wound infections between the two groups. Conclusion Postoperative pain, complications and hospital stay showed no statistically significant differences between the SILS and the LA groups. However, our SILS method uses a single trocar and two latex tubes, so cost savings and reduced interference during surgery are expected.
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Affiliation(s)
- Jungwoo Kang
- Department of Surgery, Inje University Seoul Paik Hospital, Seoul, Korea
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A Proposal for an Evidence-Based Patients’ Selection in Single Incision Laparoscopic Appendectomy. ACTA ACUST UNITED AC 2012. [DOI: 10.5812/jmiss.7185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Agresta F, Ansaloni L, Baiocchi GL, Bergamini C, Campanile FC, Carlucci M, Cocorullo G, Corradi A, Franzato B, Lupo M, Mandalà V, Mirabella A, Pernazza G, Piccoli M, Staudacher C, Vettoretto N, Zago M, Lettieri E, Levati A, Pietrini D, Scaglione M, De Masi S, De Placido G, Francucci M, Rasi M, Fingerhut A, Uranüs S, Garattini S. Laparoscopic approach to acute abdomen from the Consensus Development Conference of the Società Italiana di Chirurgia Endoscopica e nuove tecnologie (SICE), Associazione Chirurghi Ospedalieri Italiani (ACOI), Società Italiana di Chirurgia (SIC), Società Italiana di Chirurgia d'Urgenza e del Trauma (SICUT), Società Italiana di Chirurgia nell'Ospedalità Privata (SICOP), and the European Association for Endoscopic Surgery (EAES). Surg Endosc 2012; 26:2134-2164. [PMID: 22736283 DOI: 10.1007/s00464-012-2331-3] [Citation(s) in RCA: 114] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Accepted: 04/16/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND In January 2010, the SICE (Italian Society of Endoscopic Surgery), under the auspices of the EAES, decided to revisit the clinical recommendations for the role of laparoscopy in abdominal emergencies in adults, with the primary intent being to update the 2006 EAES indications and supplement the existing guidelines on specific diseases. METHODS Other Italian surgical societies were invited into the Consensus to form a panel of 12 expert surgeons. In order to get a multidisciplinary panel, other stakeholders involved in abdominal emergencies were invited along with a patient's association. In November 2010, the panel met in Rome to discuss each chapter according to the Delphi method, producing key statements with a grade of recommendations followed by commentary to explain the rationale and the level of evidence behind the statements. Thereafter, the statements were presented to the Annual Congress of the EAES in June 2011. RESULTS A thorough literature review was necessary to assess whether the recommendations issued in 2006 are still current. In many cases new studies allowed us to better clarify some issues (such as for diverticulitis, small bowel obstruction, pancreatitis, hernias, trauma), to confirm the key role of laparoscopy (such as for cholecystitis, gynecological disorders, nonspecific abdominal pain, appendicitis), but occasionally previous strong recommendations have to be challenged after review of recent research (such as for perforated peptic ulcer). CONCLUSIONS Every surgeon has to develop his or her own approach, taking into account the clinical situation, her/his proficiency (and the experience of the team) with the various techniques, and the specific organizational setting in which she/he is working. This guideline has been developed bearing in mind that every surgeon could use the data reported to support her/his judgment.
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Affiliation(s)
- Ferdinando Agresta
- Department of General Surgery, Presidio Ospedaliero di Adria, Piazza degli Etruschi, 9, 45011 Adria, RO, Italy.
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Gill RS, Shi X, Al-Adra DP, Birch DW, Karmali S. Single-incision appendectomy is comparable to conventional laparoscopic appendectomy: a systematic review and pooled analysis. Surg Laparosc Endosc Percutan Tech 2012; 22:319-27. [PMID: 22874680 DOI: 10.1097/sle.0b013e31824f2cf8] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE Acute appendicitis remains the common gastrointestinal emergency in adults. Single-incision laparoscopic appendectomy (SILA) has been proposed as the next evolution in minimally invasive surgery. SILA is postulated to reduce postoperative pain and enhance cosmesis, while effectively removing an inflamed appendix. However, the efficacy and benefits of SILA compared with conventional laparoscopic appendectomy (CLA) remain to be determined. Our objectives were to systematically review the literature comparing SILA with CLA for acute appendicitis and perform a pooled analysis on the efficacy of SILA. METHODS Published English-language manuscripts were considered for review inclusion. A comprehensive search of electronic databases (eg, MEDLINE, EMBASE, SCOPUS, BIOSIS Previews, and the Cochrane Library) using broad search terms was completed. All comparative studies were included if they incorporated adult patients undergoing appendectomy for acute appendicitis by SILA. The primary outcomes of interest were operative time and length of hospital stay. RESULTS From a total of 366 articles, 34 articles were identified. A total of 9 comparative studies were included for pooled analysis. There was no significant difference in operative time, length of stay, pain scores, and conversion or complication rates between SILA and CLA for acute appendicitis. CONCLUSIONS This systematic review and pooled analysis demonstrates that SILA is comparable to CLA for acute appendicitis in adults. However, this review identifies the need for randomized controlled trials to clarify the efficacy of SILA compared with CLA.
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Affiliation(s)
- Richdeep S Gill
- Department of Surgery, University of Alberta, Edmonton, AB Canada
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Single-port laparoscopic spleen preserving distal pancreatectomy. Minim Invasive Surg 2012; 2012:197429. [PMID: 22482047 PMCID: PMC3317064 DOI: 10.1155/2012/197429] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2011] [Accepted: 11/21/2011] [Indexed: 02/06/2023] Open
Abstract
Single-port laparoscopic surgery has become increasingly popular, with widened indication to more types of surgery. This report will present our initial experience with spleen-preserving distal pancreatectomy technique through a small transumbilical incision using the single-port approach for a cystic tumor of pancreatic body. The surgery was done using specialized single-port instruments and normal laparoscopic instruments. The total operative time for this surgery is 233 minutes, and it was completed without drains. Patient was discharged from the hospital on the third day postoperatively in good condition.
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Tan EK, Lee VTW, Chang SKY, Ganpathi IS, Madhavan K, Lomanto D. Laparoendoscopic single-site minor hepatectomy for liver tumors. Surg Endosc 2012; 26:2086-91. [PMID: 22234591 DOI: 10.1007/s00464-011-2128-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Accepted: 12/08/2011] [Indexed: 12/12/2022]
Abstract
BACKGROUND Laparoscopic liver surgery is gaining increasing acceptance worldwide, but its frontiers are constantly challenged. Laparoendoscopic single-site surgery (LESS) has been performed for various organs, but the feasibility of LESS hepatectomies has yet to be explored fully. METHODS From May 2010 to March 2011, seven patients underwent LESS minor hepatectomies. Patient demographic, operative, and clinical data were reviewed. RESULTS Five left lateral sectionectomies, one segment 3, and one segment 5 resection were performed. The median operative time was 142 min (range, 104-171 min), and the median blood loss was 200 ml (range, 100-450 ml). The median hospital stay was 3 days (range, 1-11 days). For all the patients, the indications for surgery were suspected malignant tumors, and the surgical resection margins were clear for every patient. CONCLUSIONS Laparoendoscopic single-site minor hepatectomy is a novel modification to traditional laparoscopic surgery. The method is safe and feasible without any compromise to oncologic safety for selected patients with hepatocellular carcinoma (HCC) and colorectal liver metastases that are peripheral and smaller than 5 cm in size.
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Affiliation(s)
- Ek Khoon Tan
- Department of Surgery, National University Hospital Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 8, Singapore 119228, Singapore
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Vettoretto N. Advantages of single-incision laparoscopic appendectomy should not be just cosmetics. MINIM INVASIV THER 2011; 21:435-6. [PMID: 22200107 DOI: 10.3109/13645706.2011.649008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
Over the last three decades more surgeons have used laparoscopic appendectomy as their surgical approach of choice in the management of patients with appendicitis. This includes special groups of patients, namely, pediatric, pregnant, and obese patients. Laparoscopy has the benefit of lower morbidity, decreased rate of wound complications, faster recovery, shorter length of hospital stay, and faster return to work over open appendectomy.
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Ohno Y, Morimura T, Hayashi SI. Transumbilical laparoscopically assisted appendectomy in children: the results of a single-port, single-channel procedure. Surg Endosc 2011; 26:523-7. [PMID: 21938576 DOI: 10.1007/s00464-011-1912-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Accepted: 07/20/2011] [Indexed: 12/21/2022]
Abstract
BACKGROUND Even for pediatric patients, the use of laparoscopic appendectomy has been widely accepted, and three trocars usually are necessary to perform a laparoscopic appendectomy. However, single-port appendectomy for children represents an attractive alternative. To reduce the number of incisions and trocars, the authors have adopted a transumbilical laparoscopically assisted single-port appendectomy (TULAA) approach. This study aimed to evaluate the results of their single-channel, single-port appendectomy. METHODS A retrospective study of TULAA was performed during 12 years with 500 children ages 2-16 years (median, 10.2 years). The TULAA approach is a single-channel surgery using a 12 mm conventional single-port. The vertical incision through the umbilicus is used for laparoscopic access. Two laparoscopic instruments, a 5 mm telescope and a 5 mm grasper, are inserted simultaneously into the single-channel. The grasper holds the base of the appendix, and the appendix is exteriorized through the umbilical incision. Thereafter, a conventional appendectomy is performed extracorporeally. RESULTS The TULAA procedure was successful for 416 patients (83.2%). These successful TULAA procedures required a mean surgery time of 44.5 min. The pathologic diagnosis of the appendix was acute for 59 patients, phlegmonous for 203 patients, gangrenous for 152 patients, and not detected for two patients. Complications occurred for 47 of these patients (11.3%). Most of the complications were associated with severe intraabdominal inflammation. Two patients needed reoperation under general anesthesia. Conversion to multitrocar surgery or open appendectomy was performed for 84 of the patients (16.8%). CONCLUSIONS The TULAA procedure is a preferable operation for acute appendicitis in children because it is simple and provides good cosmetic results.
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Affiliation(s)
- Yasuharu Ohno
- Department of Pediatric Surgery, Saitama Medical University, 38 Morohongo, Moroyama, Iruma, Saitama, 350-0495, Japan.
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Vettoretto N, Mandalà V. Single port laparoscopic appendectomy: are we pursuing real advantages? World J Emerg Surg 2011; 6:25. [PMID: 21831313 PMCID: PMC3170311 DOI: 10.1186/1749-7922-6-25] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2011] [Accepted: 08/10/2011] [Indexed: 12/21/2022] Open
Abstract
Single port appendectomy, due to its cosmetic appeal and to a technique similar to classic laparoscopic appendectomy, is provoking an increasing number of publications and case series to explore its feasibility and effective improvements for patients with acute appendicitis. The margins for improvement are not so large, as laparoscopic appendectomy is, after 20 years from its beginning, still debated. A literature search has been accomplished to investigate the outcomes of the operation. 23 case series or retrospective comparisons with classic laparoscopy have been found. The numbers and low quality of the published data do not permit to draw evidence based conclusions. Still, trends seem to evidence an increase in complications especially in complicated appendicitis, which suggests caution in its dissemination outside clinical trials.
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Affiliation(s)
- Nereo Vettoretto
- Laparoscopic Surgery Unit, M. Mellini Hospital, Chiari (BS), Italy
| | - Vincenzo Mandalà
- General and Emergency Surgery, Villa Sofia-Cervello joined Hospital, Palermo, Italy
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Rehman H, Rao AM, Ahmed I. Single incision versus conventional multi-incision appendicectomy for suspected appendicitis. Cochrane Database Syst Rev 2011:CD009022. [PMID: 21735437 DOI: 10.1002/14651858.cd009022.pub2] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Appendicectomy is a well established surgical procedure used in the management of acute appendicitis. The operation can be performed with minimally invasive surgery (laparoscopic) or as an open procedure. A recent development in appendicectomy has been the introduction of less invasive single incision laparoscopic surgery, using a single multi-luminal port or multiple mono-luminal ports, through a single skin incision. There are yet unanswered questions regarding the efficacy of this new and novel technique including: patient benefit and satisfaction, complications, long-term outcomes, and survival. OBJECTIVES The aim of this review is to perform meta-analysis using data from available trials comparing single incision with conventional multi-incision laparoscopic appendicectomy for appendicitis, in order to ascertain any differences in outcome. SEARCH STRATEGY We searched the electronic databases including MEDLINE/PubMed (from 1980 to December 2010), EMBASE/Ovid (from 1980 to December 2010) and CENTRAL (The Cochrane Library 2010, Issue 11) with pre-specified terms. We also searched reference lists of relevant articles and reviews, conference proceedings and ongoing trial databases. SELECTION CRITERIA Randomised or quasi-randomised controlled trials of patients with appendicitis, or symptoms of appendicitis, undergoing laparoscopic appendicectomy, in which at least one arm involves single incision procedures and another multi-incision procedures. DATA COLLECTION AND ANALYSIS There were no RCTs or prospectively controlled trials found that met the inclusion criteria. MAIN RESULTS Three authors performed study selection independently.No studies that met the inclusion criteria of this review were identified. Current evidence exists only the form of case-series.This review has been authored as 'empty' pending the results of 5 ongoing trials. AUTHORS' CONCLUSIONS No RCTs comparing single incision laparoscopic appendectomy with multi-incision surgery could be identified. No definitive conclusions can be made at this time. Well designed prospective RCTs are required in order to evaluate benefit or harm from laparoscopic surgical approaches for appendicectomy. Until appropriate data has been reported, the institutional polices of healthcare providers must be based on the clinical judgement of experts in the field.
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Affiliation(s)
- Haroon Rehman
- General Surgery, University of Aberdeen, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, Scotland, UK, AB25 2ZD
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