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Xiao Z, Wu L, Li J, He S, Chen J, Li L, Xu D, Kang Y. Application of transumbilical single-incision laparoscopy in the treatment of complicated appendicitis in overweight/obese adolescents. BMC Pediatr 2024; 24:593. [PMID: 39294601 PMCID: PMC11409603 DOI: 10.1186/s12887-024-05076-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 09/11/2024] [Indexed: 09/20/2024] Open
Abstract
OBJECTIVE To investigate the clinical efficacy of transumbilical single-incision laparoscopic surgery in the treatment of complicated appendicitis in overweight/obese adolescents. METHODS A retrospective analysis was conducted on the clinical data of 226 adolescent patients with complicated appendicitis who were admitted to our hospital from January 2014 to June 2022. Among them, 102 cases underwent transumbilical single-incision laparoscopic appendectomy as the observation group, and another 124 cases underwent conventional three-port laparoscopic appendectomy as the control group. The surgical time, intraoperative blood loss, duration of incisional pain, postoperative flatus time, length of hospital stay, surgical site infection (SSI), satisfaction with cosmetic result, and occurrence of postoperative complications were compared between the two groups. RESULTS Both groups completed the surgery smoothly, and there were no statistically significant differences in gender, age, BMI, duration of illness, white blood cell count, and preoperative CRP value between the two groups (P > 0.05). There were no statistically significant differences in surgical time and intraoperative blood loss between the two groups (P > 0.05). However, the observation group had shorter hospital stays, shorter duration of incisional pain, shorter postoperative time to flatus, and lower overall postoperative complication rates compared to the control group, with statistically significant differences (P < 0.05). The observation group had higher satisfaction with cosmetic result compared to the control group, with statistically significant differences (P < 0.05). Both groups were followed up for one year postoperatively, and there were no occurrences of residual appendicitis or severe adhesive intestinal obstruction. CONCLUSION When proficiently mastered, the application of transumbilical single-incision laparoscopy in the treatment of complicated appendicitis in overweight/obese adolescents offers advantages such as minimal trauma, rapid recovery, fewer complications, and improved aesthetic outcomes.
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Affiliation(s)
- Zhixiang Xiao
- Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, 134 Dongjie Road, Gulou District, Fuzhou, Fujian Province, 350001, China
- Fuzhou University Affiliated Provincial Hospital, 134 Dongjie Road, Gulou District, Fuzhou, 350001, Fujian Province, China
| | - Lijing Wu
- Fujian Maternity and Child Health Hospital, Fuzhou, China
- College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Jun Li
- Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, 134 Dongjie Road, Gulou District, Fuzhou, Fujian Province, 350001, China
- Fuzhou University Affiliated Provincial Hospital, 134 Dongjie Road, Gulou District, Fuzhou, 350001, Fujian Province, China
| | - Shaohua He
- Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, 134 Dongjie Road, Gulou District, Fuzhou, Fujian Province, 350001, China
- Fuzhou University Affiliated Provincial Hospital, 134 Dongjie Road, Gulou District, Fuzhou, 350001, Fujian Province, China
| | - Jingyi Chen
- Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, 134 Dongjie Road, Gulou District, Fuzhou, Fujian Province, 350001, China
- Fuzhou University Affiliated Provincial Hospital, 134 Dongjie Road, Gulou District, Fuzhou, 350001, Fujian Province, China
| | - Lizhi Li
- Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, 134 Dongjie Road, Gulou District, Fuzhou, Fujian Province, 350001, China
- Fuzhou University Affiliated Provincial Hospital, 134 Dongjie Road, Gulou District, Fuzhou, 350001, Fujian Province, China
| | - Di Xu
- Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, 134 Dongjie Road, Gulou District, Fuzhou, Fujian Province, 350001, China
- Fuzhou University Affiliated Provincial Hospital, 134 Dongjie Road, Gulou District, Fuzhou, 350001, Fujian Province, China
| | - Yingquan Kang
- Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, 134 Dongjie Road, Gulou District, Fuzhou, Fujian Province, 350001, China.
- Fuzhou University Affiliated Provincial Hospital, 134 Dongjie Road, Gulou District, Fuzhou, 350001, Fujian Province, China.
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Sanmoto Y, Goto Y, Shirane K, Kawami A, Masumoto K. Factors prolonging the operative time for transumbilical laparoscopic-assisted appendectomy in pediatric patients: a retrospective single-center study. Surg Today 2024:10.1007/s00595-024-02896-w. [PMID: 38963541 DOI: 10.1007/s00595-024-02896-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 06/11/2024] [Indexed: 07/05/2024]
Abstract
PURPOSE Transumbilical laparoscopic-assisted appendectomy (TULAA) is one of the first endoscopic surgeries performed by trainee pediatric surgeons. While the operative time is generally shorter than for conventional laparoscopic appendectomy, the indications for this procedure are unclear and many unknown factors can prolong the operative time. We conducted this study to identify the factors that may prolong the operative time for TULAA. METHODS This retrospective, single-center study was conducted between 2015 and 2023. We performed multivariate analysis to identify the factors associated with prolonged operative time by analyzing TULAA procedures performed by trainees. RESULTS The study included 243 patients. The median operative time was 84 min (interquartile range, 69-114 min). Multivariate analysis revealed that an increased body mass index, elevated C-reactive protein level, a history of conservative treatment for acute appendicitis, and appendix perforation, for the patient; < 6 years' experience since graduation for the operating surgeon; and lack of board certification as a supervisor from the Japanese Society of Pediatric Surgeons for the attending surgeon were independent risk factors for prolonging the operative time. CONCLUSION Having an attending surgeon with board certification as a supervisor by the Japanese Society of Pediatric Surgeons contributes to reducing the operative time required for TULAA.
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Affiliation(s)
- Yohei Sanmoto
- Department of Pediatric Surgery, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba-shi, 305-8576, Japan.
| | - Yudai Goto
- Department of Pediatric Surgery, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba-shi, 305-8576, Japan
| | - Kazuki Shirane
- Department of Pediatric Surgery, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba-shi, 305-8576, Japan
| | - Akio Kawami
- Department of Pediatric Surgery, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba-shi, 305-8576, Japan
| | - Kouji Masumoto
- Department of Pediatric Surgery, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba-shi, 305-8576, Japan
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Lin Y, Chen S, Lin Y, Zhang L, Wang J, Qiu X, Xu D, Li L. A trans-umbilical single-site plus one robotic-assisted surgery for choledochal cyst resection in children. Front Pediatr 2024; 12:1418991. [PMID: 38978841 PMCID: PMC11228950 DOI: 10.3389/fped.2024.1418991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 05/20/2024] [Indexed: 07/10/2024] Open
Abstract
Objective The purpose of this study is to compare the intraoperative and postoperative outcomes of a trans-umbilical single-site plus one robot-assisted surgery and a trans-umbilical single-site laparoscopic surgery in the treatment of choledochal cysts. Methods We retrospectively analyzed clinical data from 49 children diagnosed with choledochal cysts who were admitted to our hospital between June 2020 and December 2023. Among these patients, 24 underwent a trans-umbilical single-site plus one Da Vinci robot-assisted surgery (the robot group) and 25 underwent a trans-umbilical single-site laparoscopic-assisted surgery (the laparoscopic group). We compared differences in intraoperative and postoperative outcomes between the two groups. Results There was no significant difference between the two groups of patients in terms of gender, age, weight, clinical symptoms, maximum cyst diameter, type, postoperative complications, and facial expression, leg movement, activity, crying, and comfortability (FLACC) scoring (p > 0.05). Compared with the patients in the laparoscopic group, those in the robot group had less intraoperative bleeding [10 (8-12) vs. 15 (11.5-18) ml, p < 0.001] and required less postoperative drainage tube indwelling time [5 (4-6) vs. 7 (5.5-8) day, p < 0.001], less postoperative fasting time [4 (3-4) vs. 6 (5-7) days, p < 0.001], and less postoperative hospitalization time [6 (6-7) vs. 8 (6-10) days, p < 0.001], but they required more operative time [385.5 (317.0-413.3) vs. 346.0 (287.0-376.5) min, p = 0.050] and consumed more hospitalization expenses (79,323 ± 3,124 vs. 31,121 ± 2,918 yuan, p < 0.001). Conclusion The results of this study showed a shorter hospitalization time, quicker postoperative recovery, and less tissue damage but a higher cost and a longer operation time in patients who chose robotic surgery rather than laparoscopic surgery. With the continuous expansion of the scale of installed robot-assisted surgical systems and the gradual accumulation of the technical experience of surgeons, robot-assisted surgery may slowly surpass, and shows a trend to replace, laparoscopy because of its advantages.
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Affiliation(s)
- Yucan Lin
- Department of Pediatric Surgery, Fujian Provincial Hospital, Fujian Provincial Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China
| | - Shan Chen
- Department of Laboratory, Fuzhou Second General Hospital, Fuzhou, Fujian, China
| | - Yang Lin
- Department of Pediatric Surgery, Fujian Provincial Hospital, Fujian Provincial Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China
| | - Ling Zhang
- Department of Pediatric Surgery, Fujian Provincial Hospital, Fujian Provincial Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China
| | - Jianbin Wang
- Department of Pediatric Surgery, Fujian Provincial Hospital, Fujian Provincial Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China
| | - Xinyi Qiu
- Department of Pediatric Surgery, Fujian Provincial Hospital, Fujian Provincial Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China
| | - Di Xu
- Department of Pediatric Surgery, Fujian Provincial Hospital, Fujian Provincial Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China
| | - Lizhi Li
- Department of Pediatric Surgery, Fujian Provincial Hospital, Fujian Provincial Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China
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Cirocchi R, Cianci MC, Amato L, Properzi L, Buononato M, Di Rienzo VM, Tebala GD, Avenia S, Iandoli R, Santoro A, Vettoretto N, Coletta R, Morabito A. Laparoscopic appendectomy with single port vs conventional access: systematic review and meta-analysis of randomized clinical trials. Surg Endosc 2024; 38:1667-1684. [PMID: 38332174 PMCID: PMC10978699 DOI: 10.1007/s00464-023-10659-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 12/22/2023] [Indexed: 02/10/2024]
Abstract
BACKGROUND Conventional three-access laparoscopic appendectomy (CLA) is currently the gold standard treatment, however, Single-Port Laparoscopic Appendectomy (SILA) has been proposed as an alternative. The aim of this systematic review/meta-analysis was to evaluate safety and efficacy of SILA compared with conventional approach. METHODS Per PRISMA guidelines, we systematically reviewed randomised controlled trials (RCTs) comparing CLA vs SILA for acute appendicitis. The randomised Mantel-Haenszel method was used for the meta-analysis. Statistical data analysis was performed with the Review Manager software and the risk of bias was assessed with the Cochrane "Risk of Bias" assessment tool. RESULTS Twenty-one studies (RCTs) were selected (2646 patients). The operative time was significantly longer in the SILA group (MD = 7,32), confirmed in both paediatric (MD = 9,80), (Q = 1,47) and adult subgroups (MD = 5,92), (Q = 55,85). Overall postoperative morbidity was higher in patients who underwent SILA, but the result was not statistically significant. In SILA group were assessed shorter hospital stays, fewer wound infections and higher conversion rate, but the results were not statistically significant. Meta-analysis was not performed about cosmetics of skin scars and postoperative pain because different scales were used in each study. CONCLUSIONS This analysis show that SILA, although associated with fewer postoperative wound infection, has a significantly longer operative time. Furthermore, the risk of postoperative general complications is still present. Further studies will be required to analyse outcomes related to postoperative pain and the cosmetics of the surgical scar.
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Affiliation(s)
- Roberto Cirocchi
- Department of Medicine and Surgery, S. Maria Hospital, University of Perugia, Terni, Italy.
| | - Maria Chiara Cianci
- Department of Neonatal and Paediatric Surgery, Meyer Children's Hospital, IRCCS, University of Florence, Florence, Italy
| | - Lavinia Amato
- General and Emergency Surgery, S. Maria della Stella Hospital, Orvieto, Italy
| | - Luca Properzi
- Department of Medicine and Surgery, S. Maria Hospital, Perugia, Italy
| | - Massimo Buononato
- General and Emergency Surgery, S. Maria della Stella Hospital, Orvieto, Italy
| | | | | | - Stefano Avenia
- Department of Medicine and Surgery, S. Maria Hospital, University of Perugia, Terni, Italy
| | - Ruggero Iandoli
- General Surgery P.O. Frangipane Ariano Irpino Asl AV, Ariano Irpino, Italy
| | | | | | - Riccardo Coletta
- Department of Neonatal and Paediatric Surgery, Meyer Children's Hospital, IRCCS, University of Florence, Florence, Italy
| | - Antonino Morabito
- Department of Neonatal and Paediatric Surgery, Meyer Children's Hospital, IRCCS, University of Florence, Florence, Italy
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