Adopting Single-Incision Laparoscopic Appendectomy in Children: Is It Safe During the Learning Curve?

Area of Science:

• Pediatric Surgery
• Surgical Innovation
• Appendicitis Management

Background:

• Laparoscopic appendectomy is standard for acute appendicitis.
• Single-incision laparoscopic surgery (SILS) is increasingly adopted.
• Evaluating the SILS learning curve and early safety is crucial.

Purpose of the Study:

• To assess the learning curve for surgeons performing SILS appendectomy.
• To evaluate the safety of SILS appendectomy during the initial learning phase.
• To compare outcomes of SILS appendectomy with multiport laparoscopy.

Main Methods:

• Retrospective review of 974 pediatric appendectomy cases (2005-2018).
• Subgroup analysis of 438 SILS appendectomies.
• Analysis of operative time and complication rates using log-logistics and Loess models.

Main Results:

• Operative times decreased with increased SILS case experience.
• Surgeons are expected to reach experienced levels after approximately 51 cases.
• No significant difference in complication rates was observed during the early SILS learning curve compared to multiport laparoscopy.

Conclusions:

• Increased SILS case volume correlates with reduced operative times.
• The learning stage of SILS appendectomy does not increase complication rates for perforated or nonperforated appendicitis.
• SILS appendectomy is a safe and efficient approach for pediatric appendicitis, even during the initial learning phase.