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Guner OS, Tumay LV, Gurluler E. Comparison of single-incision laparoscopic appendectomy and conventional laparoscopic appendectomy for the treatment of acute appendicitis. Chirurgia (Bucur) 2020. [DOI: 10.23736/s0394-9508.19.04953-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Zhou H, Jin K, Zhang J, Wang W, Sun Y, Ruan C, Hu Z. Single incision versus conventional multiport laparoscopic appendectomy: a systematic review and meta-analysis of randomized controlled trials. Dig Surg 2014; 31:384-91. [PMID: 25547093 DOI: 10.1159/000369217] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 10/19/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND The efficacy of single incision laparoscopic appendectomy (SILA) in comparison with conventional multiport laparoscopic appendectomy (CMLA) has not been conclusively determined. METHODS A systematic literature review (Medline, EMBASE, Science Citation Index, and Cochrane Central Register of Controlled Trials) was performed. Meta-analyses of randomized controlled trials (RCTs) comparing SILA with CMLA were carried out by RevMan 5.0 software. RESULTS Eleven RCTs comparing SILA and CMLA were included. Overall, 1,216 patients were operated on: 611 cases by SILA versus 605 cases by CMLA. Compared with CMLA, SILA was associated with increased procedural difficulty, prolonged procedural duration, shorter length of hospital stay, earlier return to normal activity and better cosmesis. There were no significant differences in postoperative pain scores and complication rates between SILA and CMLA. CONCLUSION The current best evidence shows SILA holds the promise of improving postoperative recovery and cosmetic result with equal efficacy and safety, whereas it is associated with higher surgical difficulty with longer surgical time when compared with CMLA.
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Affiliation(s)
- Haiyang Zhou
- Department of General Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, PR China
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Liang HH, Hung CS, Wang W, Tam KW, Chang CC, Liu HH, Yen KL, Wei PL. Single-incision versus conventional laparoscopic appendectomy in 688 patients: a retrospective comparative analysis. Can J Surg 2014; 57:E89-97. [PMID: 24869622 DOI: 10.1503/cjs.023812] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Laparoscopic surgery has become the standard for treating appendicitis. The cosmetic benefits of using single-incision laparoscopy are well known, but its duration, complications and time to recovery have not been well documented. We compared 2 laparoscopic approaches for treating appendicitis and evaluated postoperative pain, complications and time to full recovery. METHODS We retrospectively reviewed the cases of consecutive patients with appendicitis and compared those who underwent conventional laparoscopic appendectomy (CLA) performed using 3 incisions and those who underwent single-incision laparoscopic appendectomy (SILA). During SILA, the single port was prepared to increase visibility of the operative site. RESULTS Our analysis included 688 consecutive patients: 618 who underwent CLA and 70 who underwent SILA. Postsurgical complications occurred more frequently in the CLA than the SILA group (18.1% v. 7.1%, p = 0.018). Patients who underwent SILA returned to oral feeding sooner than those who underwent CLA (median 12 h v. 22 h, p < 0.001). These between-group differences remained significant after controlling for other factors. Direct comparison of only nonperforated cases, which was determined by pathological examination, revealed that SILA was significantly longer than CLA (60 min v. 50 min, p < 0.001). Patients who underwent SILA had longer in-hospital stays than those who underwent CLA (72 v. 55 h, p < 0.001); however, they had significantly fewer complications (3.0% v. 14.4%, p = 0.006). CONCLUSION In addition to its cosmetic advantages, SILA led to rapid recovery and no increase in postsurgical pain or complications.
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Affiliation(s)
- Hung-Hua Liang
- The Division of General Surgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei Medical University, Taipei, Taiwan
| | - Chin-Sheng Hung
- The Division of General Surgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei Medical University, Taipei, Taiwan
| | - Weu Wang
- The Division of General Surgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei Medical University, Taipei, Taiwan
| | - Ka-Wai Tam
- The Division of General Surgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei Medical University, Taipei, Taiwan
| | - Chun-Chao Chang
- The Division of Gastroenterology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan
| | - Hui-Hsiung Liu
- The Graduate Institute of Public Health, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ko-Li Yen
- The Division of General Surgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei Medical University, Taipei, Taiwan
| | - Po-Li Wei
- The Division of General Surgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei Medical University, Taipei, Taiwan
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One, two or three port appendectomy - a rational approach. Wideochir Inne Tech Maloinwazyjne 2013; 8:226-31. [PMID: 24130637 PMCID: PMC3796724 DOI: 10.5114/wiitm.2011.33991] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2012] [Revised: 01/12/2013] [Accepted: 02/02/2013] [Indexed: 11/23/2022] Open
Abstract
Introduction Laparoscopic appendectomy is a safe and feasible technique accepted by many surgeons as the gold standard approach for the treatment of acute appendicitis in children. Traditionally laparoscopic appendectomy requires the use of three ports. However, surgical techniques with fewer ports have been reported. Aim To evaluate the efficacy of laparoscopic appendectomy in children according to the proposed 3-step protocol using one, two or three ports. Material and methods A total of 100 children with the diagnosis of acute appendicitis underwent laparoscopic appendectomy. Patients were treated according to the following protocol: transumbilical access with one 10 mm port using the laparoscope with working channel. The appendix was mobilized and delivered through the umbilical port and tied extracorporeally and removed. If the appendix was placed retrocecally or had adhesions, a second port was introduced. The appendix was mobilized and finally retrieved from the abdominal cavity through the camera port, and resected extracorporeally. In the cases of very short and gangrenous appendix and immobile colon, a third port was introduced and totally intra-abdominal appendectomy was performed. Patients were evaluated regarding the duration of the operation, and operative and postoperative complications. Results During the study period 100 children (58 males, 42 females) had laparoscopic appendectomy: 48 children by one-port technique (group I), 27 children by two-port technique (group II) and 25 children by three-port technique (group III). The mean operative time was 33 min (20-55 min) in group I, 39 min in group II (23-60 min), and 49 min (30-75 min) in group III. There were no intraoperative complications. Wound infections were recorded in 4 (8.3%) patients in group I, three (11.1%) in group II and four (16.0%) in group III. One patient in group III developed an abdominal abscess managed conservatively. Conclusions One-port laparoscopic appendectomy is a feasible technique in children. It allows 48% of children to have the operation. The addition of a second port allows one to mobilize the appendix and perform extracorporeal resection in an additional 27% of cases. These approaches have shorter operative time compared to 3-port technique. Laparoscopic extracorporeal appendectomy, especially one-port, is found to be cost effective and have excellent cosmetic results.
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Vettoretto N, Montori G, Bartoli M, Giovanetti M. Lesson learned from 10 years’ experience in laparoscopic appendectomy in a community hospital. Updates Surg 2012; 64:285-8. [PMID: 22991328 DOI: 10.1007/s13304-012-0177-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Accepted: 09/06/2012] [Indexed: 12/24/2022]
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Blinman T, Ponsky T. Pediatric minimally invasive surgery: laparoscopy and thoracoscopy in infants and children. Pediatrics 2012; 130:539-49. [PMID: 22869825 DOI: 10.1542/peds.2011-2812] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
This article discusses the potential benefits and challenges of minimally invasive surgery for infants and small children, and discusses why pediatric minimally invasive surgery is not yet the surgical default or standard of care. Minimally invasive methods offer advantages such as smaller incisions, decreased risk of infection, greater surgical precision, decreased cost of care, reduced length of stay, and better clinical information. But none of these benefits comes without cost, and these costs, both monetary and risk-based, rise disproportionately with the declining size of the patient. In this review, we describe recent progress in minimally invasive surgery for infants and children. The evidence for the large benefits to the patient will be presented, as well as the considerable, sometimes surprising, mechanical and physiological challenges surgeons must manage.
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Affiliation(s)
- Thane Blinman
- Children's Hospital of Philadelphia, 34th and Civic Center, Philadelphia, PA 19083, USA.
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