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Single-Incision Laparoscopic Appendectomy Using Standard 5 mm Trocars: Single Pediatric Center Experience.

Joe Rodriguez1, Michael Vogel1, Diana Fan1

  • 1Department of Pediatric Surgery, SSM Cardinal Glennon Children's Hospital, St. Louis University School of Medicine, Saint Louis, Missouri, USA.

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Summary
This summary is machine-generated.

Single-incision laparoscopic appendectomy (SILA) using standard instruments is noninferior to conventional laparoscopic appendectomy (CLA) for uncomplicated appendicitis. This technique offers a shorter operative time without compromising patient outcomes.

Keywords:
laparoscopic appendectomyminimally invasivesingle incision

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Area of Science:

  • Minimally Invasive Surgery
  • Surgical Outcomes Research
  • Pediatric Surgery

Background:

  • Single-incision laparoscopic appendectomy (SILA) typically requires specialized equipment.
  • Our institution employs SILA using standard laparoscopic instruments, reducing the need for specialized materials.
  • Previous documentation exists for SILA, but further validation of its noninferiority with standard equipment is warranted.

Purpose of the Study:

  • To demonstrate the noninferiority of our institution's SILA technique for uncomplicated appendicitis.
  • To compare outcomes between SILA using standard instruments and conventional laparoscopic appendectomy (CLA).
  • To evaluate the efficacy and safety of SILA in a real-world clinical setting.

Main Methods:

  • Retrospective review of 128 patients who underwent SILA for uncomplicated appendicitis from 2011 to 2020.
  • Exclusion of patients with perforated appendicitis.
  • Matching SILA cases with up to three CLA controls based on age, gender, and weight using the Greedy match method.

Main Results:

  • SILA demonstrated a significantly shorter operative time (27.2 minutes) compared to CLA (43.7 minutes) (P < .001).
  • No significant difference was observed in mean length of stay (LOS) between SILA and CLA (42.4 hours vs. 42.4 hours, P = .88).
  • Complication rates (5.4% vs. 8.5%, P = .06) and readmission rates (0.8% vs. 3.4%, P = .108) were comparable between the two groups.

Conclusions:

  • Our SILA technique, utilizing standard laparoscopic instrumentation, is noninferior to CLA for treating uncomplicated appendicitis.
  • The SILA approach resulted in a reduced operative time, suggesting potential efficiency gains.
  • These findings support the use of SILA with standard equipment for selected patients, offering a viable alternative to CLA.