Holder-free single-port laparoscopic appendectomy as solo surgery and learning curve analysis of 100 cases

Acute appendicitis (AA) is a common condition that is typically treated with laparoscopic appendectomy (LA). Single-port laparoscopic appendectomy (SLA) offers potential benefits, such as reduced trauma and improved cosmesis. This study introduces a novel technique, Holder-Free Solo-SLA (HFSSLA), which is performed without an assistant or mechanical arm. A retrospective analysis of 100 consecutive HFSSLA patients performed by a single operator was conducted. The technique involved a single 2 cm umbilical incision and intra-abdominal operation using conventional laparoscopic equipment. The learning curve was assessed using CUSUM and MF-CUSUM analyses. According to the CUSUM and MF-CUSUM curves, inflection points occurred in the 36th and 26th patients, respectively. The mean operative duration was 55.58 min, which decreased to 50 min after the learning curve inflection point. Postoperative complications and cosmetic scores improved significantly after this point. This study demonstrated that as surgical experience increased, the efficiency and the safety of the operation improved. HFSSLA is a feasible technique for treating AA, with improved outcomes as surgeon familiarity increases. The technique's potential benefits should be weighed against its technical challenges and risks. Further research is needed to optimize the procedure and assess its applicability in various patient populations.