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Single-incision laparoscopic appendectomy is a safe procedure for beginners to perform: experience from 1948 cases

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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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Authors and Affiliations

  1. 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

    Gyeo Ra Lee, Ji Hoon Kim, Chang Hyun Kim & Jin Jo Kim

  2. Department of Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Korea

    Yoon Suk Lee

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  1. Gyeo Ra Lee
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Correspondence to Ji Hoon Kim.

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The authors (Gyeo Ra Lee, Ji Hoon Kim, Chang Hyun Kim, Yoon Suk Lee, Jin Jo Kim) have no conflicts of interest relevant to this study to disclose.

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Lee, G.R., Kim, J.H., Kim, C.H. et al. Single-incision laparoscopic appendectomy is a safe procedure for beginners to perform: experience from 1948 cases. Surg Endosc 35, 2997–3002 (2021). https://doi.org/10.1007/s00464-020-07744-9

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  • DOI: https://doi.org/10.1007/s00464-020-07744-9

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