Single-Port Laparoscopic Appendectomy Versus Conventional Laparoscopic Appendectomy A Prospective Randomized Controlled Study

From the Department of Surgery, Gil Medical Center, Gachon University, School of Medicine, Incheon, Korea.
Annals of surgery (Impact Factor: 7.19). 12/2012; 257(2). DOI: 10.1097/SLA.0b013e318273bde4
Source: PubMed

ABSTRACT OBJECTIVE:: To compare surgical outcomes and quality of life between single-port laparoscopic appendectomy (SPLA) and conventional laparoscopic appendectomy (CLA) in patients with acute appendicitis. BACKGROUND:: A prospective randomized single center study was performed to compare the outcome of SPLA and CLA in patients with acute appendicitis. METHODS:: A total of 248 patients were randomized, but because of 18 withdrawals, the outcome of 224 is analyzed, 116 in CLA and 114 in SPLA. RESULTS:: There was no significant difference in the overall complication rate (P = 0.470). There were no significant differences in infectious complications between the SPLA group and the CLA group (10.2% and 12.4%, respectively). The wound complication rate between the 2 groups was not significant (5.1% and 10.6%, respectively; P = 0.207). Cosmetic satisfaction score, 36-item short-form health survey, and postoperative pain scores were not significantly different between 2 groups. CONCLUSIONS:: SPLA failed to show any advantages over CLA relative to pain and cosmesis. However, SPLA is as safe as CLA (RCT number 01348464).

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    • "Sozutek A et al. 2013 25 25 30.6±12.4 30±11 12:13 7:18 23.2±3.79 23.1±2..58 Lee WS et al. 2013 116 113 "
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    ABSTRACT: PURPOSE: To assess the efficacy and safety of single-incision laparoscopic appendectomy (SILA), we conducted a meta-analysis of randomized controlled trials (RCTs) comparing conventional three-port laparoscopic appendectomy (CTLA). METHODS: RCTs comparing the effects of SILA and CTLA were searched for in PubMed, the Cochrane Central Register of Controlled Trials, and Embase. Operative time, the pain visual analogue scales scores (VAS scores), dose of analgesics, postoperative complications, hospital charges, and duration of postoperative hospitalization in SILA and CTLA were pooled and compared by meta-analysis. Odds ratios and weighted mean differences (WMDs) were calculated with 95 % confidence intervals (CIs) to evaluate the effect of SILA. RESULT: Eight original RCTs investigating 760 adults and 684 children, 1,444 patients in total, of whom 721 received SILA only and 723 received CTLA only, met the inclusion criteria. Both in adults and children, the mean operative time was significantly longer in SILA than CTLA (WMD5.45, 95 % CI 2.15 to 8.75, p = 0.01). Compared with CTLA, in children, SILA have higher analgesic consumption (WMD 0.69, 95 % CI 0.08 to 1.3, p = 0.03) and greater hospital charges (WMD 0.87, 95 % CI 1.26 to 1.48, p = 0.005), which was not statistically different in adults (p > 0.05). Pooling the results for SILA and CTLA revealed no significant difference in VAS scores, wound infection rate, overall complications, and postoperative hospital stay. CONCLUSION: SILA failed to show any obvious advantages over CTLA in perioperative and postoperative outcomes. Therefore, it represents a possible alternative to conventional three-port laparoscopic appendectomy.
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    ABSTRACT: Background Single-incision laparoscopic appendectomy has emerged as a less invasive alternative to conventional laparoscopic surgery. High quality relevant evidence is limited. Methods A systematic review of the electronic information sources was undertaken, with the objective to identify randomized trials that compared single-incision with conventional laparoscopic appendectomy. Outcome measures included 30-day morbidity, abdominal abscess, wound infection, open conversion, reoperation, operative time, length of hospital stay, and postoperative pain. The fixed- and random effects models were used in order to calculate combined overall effect sizes of pooled data. Data are presented as the odds ratio (OR) or weighted mean difference (WMD) with 95% confidence interval (CI). Results Five randomized trials were identified with a total number of 746 patients. Thirty-day morbidity (9.6% vs. 8.6%; OR 1.14, 95% CI 0.69-1.89) and wound infection rates were similar between single-incision and conventional laparoscopy (4.0% vs. 4.8%; OR 0.83, 95% CI 0.41-1.68), whereas duration of surgery was longer in the single-incision group (46.3 vs. 40.7 min.; WMD 6.01, 95% CI 2.26-9.76). Available data were not adequately robust to reach conclusions regarding the remaining outcome measures. Conclusions Similar postoperative morbidity and wound infection rates for single-incision and conventional laparoscopic appendectomy are supported by the current literature, however, single-incision surgery requires longer operative time.
    American journal of surgery 01/2013; 207(4). DOI:10.1016/j.amjsurg.2013.07.045 · 2.41 Impact Factor
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    ABSTRACT: Background: The single-incision laparoscopic approach for cholecystectomy has been reported to be cosmetically superior in the traditional four-port technique in several case series; however, prospective comparative data are lacking. We conducted a 60-patient, prospective, randomized trial comparing single-incision laparoscopic cholecystectomy with standard four-port cholecystectomy, including validated scar assessment evaluation around 6 weeks and 18 months after the operation in an effort to determine if a cosmetic advantage existed. Patients and Methods: Patients over 12 years of age and parents of patients under 12 years of age enrolled in the trial were asked to complete the validated Patient Scar Assessment Questionnaire (PSAQ). The PSAQ consists of four subscales: Appearance, Consciousness, Satisfaction with Appearance, and Satisfaction with Symptoms. The Symptoms subscale is omitted from analysis per PSAQ instructions because of insufficient reliability. Each subscale is a set of items with 4-point categorical responses (from 1=most favorable to 4=least favorable). The sum of the questions quantifies each subscale. Data are expressed as mean±standard deviation values. Results: Eighteen single-site patients and 8 four-port patients completed early questionnaires, in which there was no difference in overall scar assessment (P=.17). Telephone follow-up was accomplished for 17 single-site patients and 24 four-port patients and revealed that the overall scar assessment significantly favored the single-site approach (P=.04). Conclusions: Patients or parents of patients do not identify an overall superior scar assessment at early follow-up after single-site laparoscopic versus four-port cholecystectomy. However, they do perceive a superior scar assessment at long-term follow-up, suggesting that there is a cosmetic benefit favoring the single-site approach.
    Journal of Laparoendoscopic & Advanced Surgical Techniques 06/2013; 23(6):553-5. DOI:10.1089/lap.2013.0245 · 1.19 Impact Factor