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

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.