Skip to main content

Advertisement

SpringerLink
Log in

Single-incision versus multiport laparoscopic appendectomy: a case-matched comparative analysis

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Addiss DG, Shaffer N, Fowler BS, Tauxe RV (1990) The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol 132:910–925

    CAS  PubMed  Google Scholar 

  2. McBurney C (1894) IV. 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

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  3. Semm K (1983) Endoscopic appendectomy. Endoscopy 15:59–64

    Article  CAS  PubMed  Google Scholar 

  4. Ingraham AM, Cohen ME, Bilimoria KY, Pritts TA, Ko CY, Esposito TJ (2010) Comparison of outcomes after laparoscopic versus open appendectomy for acute appendicitis at 222 ACS NSQIP hospitals. Surgery 148:625–635 discussion 635-627

    Article  PubMed  Google Scholar 

  5. Wei B, Qi CL, Chen TF, Zheng ZH, Huang JL, Hu BG, Wei HB (2011) Laparoscopic versus open appendectomy for acute appendicitis: a metaanalysis. Surg Endosc 25:1199–1208

    Article  PubMed  Google Scholar 

  6. Guller U, Hervey S, Purves H, Muhlbaier LH, Peterson ED, Eubanks S, Pietrobon R (2004) Laparoscopic versus open appendectomy: outcomes comparison based on a large administrative database. Ann Surg 239:43–52

    Article  PubMed Central  PubMed  Google Scholar 

  7. Cotton M (2014) Single-port Cholecystectomy and Quality of Life. World J Surg 38:264

    Article  PubMed  Google Scholar 

  8. Beck C, Eakin J, Dettorre R, Renton D (2013) Analysis of perioperative factors and cost comparison of single-incision and traditional multi-incision laparoscopic cholecystectomy. Surg Endosc 27:104–108

    Article  PubMed  Google Scholar 

  9. Tunca F, Senyurek YG, Terzioglu T, Iscan Y, Tezelman S (2012) Single-incision laparoscopic adrenalectomy. Surg Endosc 26:36–40

    Article  PubMed  Google Scholar 

  10. Egi H, Hattori M, Hinoi T, Takakura Y, Kawaguchi Y, Shimomura M, Tokunaga M, Adachi T, Urushihara T, Itamoto T, Ohdan H (2012) Single-port laparoscopic colectomy versus conventional laparoscopic colectomy for colon cancer: a comparison of surgical results. World J Surg Oncol 10:61

    Article  PubMed Central  PubMed  Google Scholar 

  11. 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

    Article  CAS  PubMed  Google Scholar 

  12. Chouillard E, Dache A, Torcivia A, Helmy N, Ruseykin I, Gumbs A (2010) Single-incision laparoscopic appendectomy for acute appendicitis: a preliminary experience. Surg Endosc 24:1861–1865

    Article  PubMed  Google Scholar 

  13. Raman JD, Bagrodia A, Cadeddu JA (2009) Single-incision, umbilical laparoscopic versus conventional laparoscopic nephrectomy: a comparison of perioperative outcomes and short-term measures of convalescence. Eur Urol 55:1198–1204

    Article  PubMed  Google Scholar 

  14. Chow A, Purkayastha S, Paraskeva P (2009) Appendicectomy and cholecystectomy using single-incision laparoscopic surgery (SILS): the first UK experience. Surg Innov 16:211–217

    Article  PubMed  Google Scholar 

  15. Canes D, Desai MM, Aron M, Haber GP, Goel RK, Stein RJ, Kaouk JH, Gill IS (2008) Transumbilical single-port surgery: evolution and current status. Eur Urol 54:1020–1029

    Article  PubMed  Google Scholar 

  16. Ciarrocchi A, Amicucci G (2014) Laparoscopic versus open appendectomy in obese patients: a meta-analysis of prospective and retrospective studies. J Minim Access Surg 10:4–9

    Article  PubMed Central  PubMed  Google Scholar 

  17. Lee J, Baek J, Kim W (2010) Laparoscopic transumbilical single-port appendectomy: initial experience and comparison with three-port appendectomy. Surg Laparosc Endosc Percutan Tech 20:100–103

    Article  PubMed  Google Scholar 

  18. Schwack BF, Novack R, Youn H, Fielding CR, Kurian MS, Fielding GA (2013) Single-incision laparoscopic adjustable gastric banding is effective and safe: 756 cases in an academic medical center. Obes Surg 23:332–337

    Article  PubMed  Google Scholar 

  19. Antoniou SA, Koch OO, Antoniou GA, Lasithiotakis K, Chalkiadakis GE, Pointner R, Granderath FA (2014) Meta-analysis of randomized trials on single-incision laparoscopic versus conventional laparoscopic appendectomy. Am J Surg 207(4):613–622

    Article  PubMed  Google Scholar 

  20. Pisanu A, Porceddu G, Reccia I, Saba A, Uccheddu A (2013) Meta-analysis of studies comparing single-incision laparoscopic appendectomy and conventional multiport laparoscopic appendectomy. J Surg Res 183:e49–e59

    Article  PubMed  Google Scholar 

  21. Cho MS, Min BS, Hong YK, Lee WJ (2011) Single-site versus conventional laparoscopic appendectomy: comparison of short-term operative outcomes. Surg Endosc 25:36–40

    Article  PubMed  Google Scholar 

  22. Lee YS, Kim JH, Moon EJ, Kim JJ, Lee KH, Oh SJ, Park SM, Hong TH (2009) Comparative study on surgical outcomes and operative costs of transumbilical single-port laparoscopic appendectomy versus conventional laparoscopic appendectomy in adult patients. Surg Laparosc Endosc Percutan Tech 19:493–496

    Article  PubMed  Google Scholar 

  23. Park J, Kwak H, Kim SG, Lee S (2012) Single-port laparoscopic appendectomy: comparison with conventional laparoscopic appendectomy. J Laparoendosc Adv Surg Tech A 22:142–145

    Article  PubMed  Google Scholar 

  24. Chow A, Purkayastha S, Nehme J, Darzi LA, Paraskeva P (2010) Single incision laparoscopic surgery for appendicectomy: a retrospective comparative analysis. Surg Endosc 24:2567–2574

    Article  PubMed  Google Scholar 

  25. Kang KC, Lee SY, Kang DB, Kim SH, Oh JT, Choi DH, Park WC, Lee JK (2010) Application of single incision laparoscopic surgery for appendectomies in patients with complicated appendicitis. J Korean Soc Coloproctol 26:388–394

    Article  PubMed Central  PubMed  Google Scholar 

  26. Vidal O, Valentini M, Ginesta C, Marti J, Espert JJ, Benarroch G, Garcia-Valdecasas JC (2010) Laparoendoscopic single-site surgery appendectomy. Surg Endosc 24:686–691

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  28. Lee WS, Choi ST, Lee JN, Kim KK, Park YH, Lee WK, Baek JH, Lee TH (2013) Single-port laparoscopic appendectomy versus conventional laparoscopic appendectomy: a prospective randomized controlled study. Ann Surg 257:214–218

    Article  PubMed  Google Scholar 

  29. Garey CL, Laituri CA, Ostlie DJ, Snyder CL, Andrews WS, Holcomb GW 3rd, St Peter SD (2011) Single-incision laparoscopic surgery in children: initial single-center experience. J Pediatr Surg 46:904–907

    Article  PubMed  Google Scholar 

  30. Ponsky TA, Diluciano J, Chwals W, Parry R, Boulanger S (2009) Early experience with single-port laparoscopic surgery in children. J Laparoendosc Adv Surg Tech A 19:551–553

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

Download references

Disclosures

Hans-Georg Liesaus and Roland Raakow are patent holders together with the Richard Wolf Medical Instruments Corporation. Jonas Raakow and Peter Neuhaus have no conflict of interest or financial ties to disclose.

Author information

Authors and Affiliations

  1. Department of General, Visceral and Transplantation Surgery, Universitätsmedizin Berlin, Charité Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany

    Jonas Raakow & Peter Neuhaus

  2. Department of General, Visceral and Vascular Surgery, Vivantes Klinikum Am Urban, Dieffenbachstrasse 1, 10967, Berlin, Germany

    Hans-Georg Liesaus & Roland Raakow

Authors
  1. Jonas Raakow
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hans-Georg Liesaus
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Peter Neuhaus
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Roland Raakow
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Jonas Raakow or Hans-Georg Liesaus.

Additional information

Jonas Raakow and Hans-Georg Liesaus contributed equally to this work.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Raakow, J., Liesaus, HG., Neuhaus, P. et al. Single-incision versus multiport laparoscopic appendectomy: a case-matched comparative analysis. Surg Endosc 29, 1530–1536 (2015). https://doi.org/10.1007/s00464-014-3837-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-014-3837-7

Keywords

Search

Navigation