Abstract
Background
Questions have emerged as to whether single-incision laparoscopy has reproducible or superior patient outcomes compared with traditional laparoscopy. A retrospective review comparing single-incision laparoscopic (SILS) appendectomy and traditional multiport laparoscopic (MP) appendectomy was conducted to assess the safety and feasibility of the less invasive laparoscopic technique.
Methods
All SILS and MP appendectomies performed by three surgeons at a single institution during 43 months were reviewed. Statistical evaluation included descriptive analysis of demographic data including age and gender, as well as bi- and multi-variate analyses of operative outcomes including operative time, conversions, complications, and hospital length of stay.
Results
The study reviewed 168 patients who underwent SILS appendectomy and 108 patients who underwent MP appendectomy. No statistically significant difference was found between the mean SILS and MP operative times (43.63 vs. 40.95 min; p = 0.29). Additionally, no statistically significant association was noted between surgical approach and length of hospital stay. Although 0.93 % of MP appendectomies and 2.38 % of SILS appendectomies were converted to open procedure, this difference was not statistically significant (p = 0.65, Fisher’s exact test). After exclusion of cases converted to open procedure from the study, the findings showed that 3.66 % of SILS cases were converted to multiport laparoscopy. No increase in the overall complication rate was associated with SILS compared with MP appendectomy. The wound complications documented included one incisional hernia for SILS appendectomy and two wound infections for MP appendectomy.
Conclusion
The findings showed SILS appendectomy to be a safe and feasible alternative to traditional MP appendectomy that can be conducted with operative times, lengths of stay, and complication rates similar to those of the standardized technique. This review is a precursor to prospective studies, which are warranted to demonstrate conclusively the equivalence of operative times, complications, and lengths of hospital stay, as well as to elucidate differences in patient-centered outcomes including postoperative pain, cosmesis, and quality of life.
Similar content being viewed by others
References
McBurney C (1894) The incision made in the abdominal wall in cases of appendicitis, with a description of a new method of operating. Ann Surg 20:38–43
Semm K (1983) Endoseopic appendectomy. Endoscopy 15:59–64
Katkhouda N, Mason R, Towfigh S, Gevorgyan A, Essani R (2005) Laparoscopic versus open appendectomy: a prospective randomized double-blind study. Ann Surg 242:439–450
Fritts L, Orlando R (1993) Laparoscopic appendectomy. Arch Surg 128:521–525
Tate JJT, Dawson JW, Chung SCS, Lau WY, Li AKC (1993) Laparoscopic versus open appendectomy: prospective randomized trial. Lancet 342:633–637
Ingraham A, Cohen M, Bilimoria K, Pritts T, Ko C, Esposito T (2010) Comparison of outcomes after laparoscopic versus open appendectomy for acute appendicitis at 222 ACS NSQIP hospitals. Surgery 148:625–637
Towfigh S, Chen F, Mason R, Kathouda N, Chan L, Berne T (2006) Laparoscopic appendectomy significantly reduces length of stay for perforated appendicitis. Surg Endosc 20:495–499
Wei B, Qi CL, Chen CF, Zheng ZH, Huang JL, Hu BG, Wei BH (2011) Laparoscopic versus open appendectomy for acute appendicitis: a meta-analysis. Surg Endosc 25:1199–1208
Muensterer OJ, Keijzer R (2011) A simple vacuum dressing reduces the wound infection rate of single-incision pediatric endosurgical appendectomy. JSLS 15:147–150
Bucher P, Pugin F, Buchs NC, Ostermann S, Morel P (2011) Randomized clinical trial of laparoendoscopic single-site versus conventional laparoscopic cholecystectomy. Br J Surg 98:1695–1702
Champagne BJ, Papaconstantinou HT, Parmar SS, Nagle DA, Young-Fadok TM, Lee EC, Delaney CP (2012) Single-incision versus standard multiport laparoscopic colectomy: a multicenter, case-controlled comparison. Ann Surg 255:66–69
Marks J, Tacchino R, Roberts K, Onders R, Denoto G, Paraskeva P, Rivas H, Soper N, Rosemurgy A, Shah S (2011) Prospective randomized controlled trial of traditional laparoscopic cholecystectomy versus single-incision laparoscopic cholecystectomy: report of preliminary data. Am J Surg 201:369–373
Gill IS, Advincula AP, Aron M, Caddedu J, Canes D, Curcillo PG II, Desai MM, Evanko JC, Falcone T, Fazio V, Gettman M, Gumbs AA, Haber GP, Kaouk JH, Kim F, King SA, Ponsky J, Remzi F, Rivas H, Rosemurgy A, Ross S, Schauer P, Sotelo R, Speranza J, Sweeney J, Teixeira J (2010) Consensus statement of the consortium for laparoendoscopic single-site surgery. Surg Endosc 24:762–768
Papaconstantinou HT, Sharp N, Thomas JS (2011) Single-incision laparoscopic right colectomy: a case-matched comparison with standard laparoscopic and hand-assisted laparoscopic techniques. J Am Coll Surg 213:72–80
Rao PP, Rao PP, Bhagwat S (2011) Single-incision laparoscopic surgery: current status and controversies. J Minim Access Surg 7:6–16
Chew MH, Chang MH, Tan WS, Wong MTC, Tang CL (2013) Conventional laparoscopic versus single-incision laparoscopic right hemicolectomy: a case cohort comparison of short-term outcomes in 144 consecutive cases. Surg Endosc 27:471–477
St Peter SD, Adibe OO, Juang D, Sharp SW, Garey CL, Laituri CA, Murphy JP, Andrews WS, Sharp RJ, Snyder CL, Holcomb GW 3rd, Ostlie DJ (2011) Single-incision versus standard three-port laparoscopic appendectomy. Ann Surg 254:586–590
Lee JA, Sung KY, Lee JH, Lee do S (2010) Laparoscopic appendectomy with a single incision in a single institute. J Korean Soc Coloproctol 26:260–264
Amos SE, Shuo-Dong W, Fan Y, Tian Y, Chen CC (2012) Single-incision versus conventional three-incision laparoscopic appendectomy: a single-centre experience. Surg Today 42:542–546
Disclosures
F. Paul Buckley and John Eckford are proctors for Covidien. Sharon Monsivais, Hannah Vassaur, Daniel Jupiter, and Rob Watson have no conflicts of interest or financial ties to disclose.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Buckley, F.P., Vassaur, H., Monsivais, S. et al. Single-incision laparoscopic appendectomy versus traditional three-port laparoscopic appendectomy: an analysis of outcomes at a single institution. Surg Endosc 28, 626–630 (2014). https://doi.org/10.1007/s00464-013-3219-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-013-3219-6