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Kim KE, Cho IS, Bae SU, Jeong WK, Kim HJ, Baek SK. A prospective randomized controlled study comparing patient-reported scar evaluation of single-port versus multiport laparoscopic appendectomy for acute appendicitis. JOURNAL OF MINIMALLY INVASIVE SURGERY 2023; 26:55-63. [PMID: 37347098 PMCID: PMC10280108 DOI: 10.7602/jmis.2023.26.2.55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/10/2023] [Accepted: 06/11/2023] [Indexed: 06/23/2023]
Abstract
Purpose This study aimed to compare the postoperative outcomes and patient-surveyed scar assessments of single-port laparoscopic appendectomy (SPLA) with the outcomes of multiport laparoscopic appendectomy (MPLA). Methods Between August 2014 and November 2017, the prospective randomized study comprised 98 patients diagnosed with acute appendicitis and indicated for surgery. Fifty-one patients had MPLA and 47 patients received SPLA. The primary endpoint was the total score of Patient Scar Assessment Questionnaire (PSAQ) administered to patients 6 weeks after surgery. Results SPLA involved a shorter median operative time than MPLA (47.5 minutes vs. 60.0 minutes, p = 0.02). There were no apparent differences in the time before diet tolerance, length of hospital stay, and postoperative complication. SPLA patients had shorter total incision length (2.0 cm vs. 2.5 cm, p < 0.01) and required fewer analgesics on the day of surgery than MPLA patients (p = 0.011). The PSAQ favored the SPLA approach, revealing significant differences in total score (48 vs. 55, p = 0.026), appearance (15 vs. 18, p = 0.002), and consciousness (8 vs. 10, p = 0.005), while satisfaction with appearance and symptoms scale did not (p = 0.162 and p = 0.690, respectively). Conclusion The postoperative scar evaluated by the patient was better with SPLA than with MPLA, and patient satisfaction with the scar was comparable between the two techniques.
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Affiliation(s)
- Kyeong Eui Kim
- Department of Surgery, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - In Soo Cho
- Department of Surgery, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Sung Uk Bae
- Department of Surgery, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Woon Kyung Jeong
- Department of Surgery, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Hyung Jin Kim
- Division of Colorectal Surgery, Department of Surgery, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Seong Kyu Baek
- Department of Surgery, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
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Köhler F, Reese L, Kastner C, Hendricks A, Müller S, Lock JF, Germer CT, Wiegering A. Surgical Site Infection Following Single-Port Appendectomy: A Systematic Review of the Literature and Meta-Analysis. Front Surg 2022; 9:919744. [PMID: 35756463 PMCID: PMC9213668 DOI: 10.3389/fsurg.2022.919744] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 04/29/2022] [Indexed: 12/29/2022] Open
Abstract
IntroductionSurgical site infections (SSIs) are one of the most common postoperative complications after appendectomy leading to recurrent surgery, prolonged hospital stay, and the use of antibiotics. Numerous studies and meta-analyses have been published on the effect of open versus conventional laparoscopic appendectomy (CLA) reporting faster postoperative recovery and less postoperative pain for CLA. A development from CLA has been the single-port appendectomy (SPA), associated with a better cosmesis but seemingly having a higher risk of wound infections. The aim of this systematic literature review and meta-analysis is to investigate whether reduced port or SPA alters the ratio of SSIs.MethodsPubmed, Embase, and Cochrane databases were screened for suitable articles. All articles published between January 1, 2002, and March 23, 2022, were included. Articles regarding children below the age of 18 were excluded as well as manuscripts that investigated solemnly open appendectomies. Articles were screened for inclusion criteria by two independent authors. Incidence of SSI was the primary outcome. Duration of operation and length of hospital stay were defined as secondary outcomes.ResultsA total of 25 studies were found through a database search describing 5484 patients. A total of 2749 patients received SPA and 2735 received CLA. There was no statistical difference in the rate of SSI (P = 0.98). A total of 22 studies including 4699 patients reported the duration of operation (2223 SPA and 2476 CLA). There was a significantly shorter operation time seen in CLA. The length of hospital stay was reported in 23 studies (4735 patients: 2235 SPA and 2500 CLA). A shorter hospital stay was seen in the SPA group (P < 0.00001). Separately performed analysis of randomized controlled trials could not confirm this effect (P = 0.29).DiscussionSPA is an equally safe procedure considering SSI compared to CLA and does not lead to an increased risk of SSI. A longer operation time for SPA and a minor difference in the length of stay does lead to the use of SPA in selected patients only.
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Affiliation(s)
- Franziska Köhler
- Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery, University Hospital, University of Wuerzburg, Wuerzburg, Germany
- Correspondence: Franziska Köhler
| | - Lena Reese
- Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery, University Hospital, University of Wuerzburg, Wuerzburg, Germany
| | - Carolin Kastner
- Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery, University Hospital, University of Wuerzburg, Wuerzburg, Germany
- Department of Biochemistry and Molecular Biology, University of Wuerzburg, Wuerzburg, Germany
| | - Anne Hendricks
- Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery, University Hospital, University of Wuerzburg, Wuerzburg, Germany
| | - Sophie Müller
- Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery, University Hospital, University of Wuerzburg, Wuerzburg, Germany
| | - Johan F. Lock
- Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery, University Hospital, University of Wuerzburg, Wuerzburg, Germany
| | - Christoph-Thomas Germer
- Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery, University Hospital, University of Wuerzburg, Wuerzburg, Germany
- Comprehensive Cancer Center Mainfranken, University of Wuerzburg Medical Centre, Wuerzburg, Germany
| | - Armin Wiegering
- Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery, University Hospital, University of Wuerzburg, Wuerzburg, Germany
- Department of Biochemistry and Molecular Biology, University of Wuerzburg, Wuerzburg, Germany
- Comprehensive Cancer Center Mainfranken, University of Wuerzburg Medical Centre, Wuerzburg, Germany
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Petroianu A. Relevant aspects of acute appendicitis. Rev Assoc Med Bras (1992) 2022; 68:121-124. [PMID: 35239865 DOI: 10.1590/1806-9282.20211315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 01/06/2022] [Indexed: 11/22/2022] Open
Affiliation(s)
- Andy Petroianu
- Universidade Federal de Minas Gerais, Department of Surgery - Belo Horizonte (MG), Brazil
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Guner OS, Tumay LV, Gurluler E. Comparison of single-incision laparoscopic appendectomy and conventional laparoscopic appendectomy for the treatment of acute appendicitis. Chirurgia (Bucur) 2020. [DOI: 10.23736/s0394-9508.19.04953-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Comparison of Technical Details and Short-term Outcomes of Single-incision Versus Multiport Laparoscopic Adrenalectomy. Surg Laparosc Endosc Percutan Tech 2019; 29:49-52. [PMID: 30605138 DOI: 10.1097/sle.0000000000000596] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
To date, the single-incision laparoscopic surgery (SILS) technique has been applied to a wide range of general surgical procedures; however, there are still scant data and debates on adrenal procedures. The aim of this study was to compare surgical outcomes of single-incision versus laparoscopic multiport adrenalectomy. The patients were divided into 2 study groups on the basis of the surgical approach: SILS (group 1) and multiport laparoscopic surgery (group 2). Patient demographics and their perioperative and postoperative results were evaluated retrospectively from the medical records. A total of 80 patients were included in the study. There were 44 patients in group 1 and 36 patients in group 2. The average operative time, estimated blood loss, and tumor size were similar between the study groups. There were no mortalities in both groups and the mean duration of hospital stay was 3 days for both groups. Without using any single-incision access trocars and articulated instrumentation, we achieved the same surgical outcomes in our SILS adrenalectomy series compared with conventional multiport laparoscopy series in terms of postoperative short-term outcomes and cost-effectivity.
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Hybrid appendectomy with classic trocar on McBurney's point. Wideochir Inne Tech Maloinwazyjne 2018; 13:57-61. [PMID: 29643959 PMCID: PMC5890840 DOI: 10.5114/wiitm.2017.70323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 09/02/2017] [Indexed: 11/22/2022] Open
Abstract
Introduction Appendectomy is still the most commonly performed intra-abdominal operation worldwide. Interestingly, it has not reached the same popularity as other laparoscopic surgical procedures. Although multiple techniques have been described, a standard approach has not been described for the laparoscopic technique yet. Aim To perform hybrid appendectomy for acute appendicitis on McBurney’s point, aiming to perform an easier and quicker procedure while limiting the trauma to the abdominal wall by obtaining the advantages of both laparoscopic and open techniques. Material and methods We retrospectively evaluated the results of 24 patients on whom we had performed hybrid appendectomy with an optical trocar on McBurney’s point for acute appendicitis in 1 year in terms of demographics, operative time, complications, hospital stay and cosmetic results. Results Twenty-one of the patients underwent hybrid appendectomy with a one-optic trocar on McBurney’s point. The mean operative time was 21.4 ±6.2 min. We did not encounter any postoperative complications in any of the patients. The median hospital stay was 1.2 ±1.0 days. The postoperative scar was minimal. Conclusions This technique is defined in the literature for the first time, and it is easy and feasible for the surgeons. It may reduce the operative time and costs when compared to the conventional laparoscopic technique, but prospective studies with more patients are needed for more certain results.
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Bartnicka J, Zietkiewicz AA, Kowalski GJ. An ergonomics study on wrist posture when using laparoscopic tools in four techniques in minimally invasive surgery. INTERNATIONAL JOURNAL OF OCCUPATIONAL SAFETY AND ERGONOMICS 2018; 24:438-449. [PMID: 29553920 DOI: 10.1080/10803548.2018.1452666] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE With reference to four minimally invasive surgery (MIS) cholecystectomies, the aims were (a) to recognize the factors influencing dominant wrist postures manifested by the surgeon; (b) to detect risk factors involved in maintaining deviated wrist postures; (c) to compare the wrist postures of surgeons while using laparoscopic tools. METHODS Video films were recorded during live surgeries. The films were synchronized with wrist joint angles obtained from wireless electrogoniometers placed on the surgeon's hand. The analysis was conducted for five laparoscopic tools used during all surgical techniques. RESULTS The most common wrist posture was extension. In the case of one laparoscopic tool, the mean values defining extended wrist posture were distinct in all four surgical techniques. For one type of surgical technique, considered the most beneficial for patients, more extreme postures were noticed regarding all laparoscopic tools. We recognized a new factor, apart from the tool's handle design, that influences extreme and deviated wrist postures. It involves three areas of task specification including the type of action, type of motion patterns and motion dynamism. CONCLUSIONS The outcomes proved that the surgical technique which is best for the patient imposes the greatest strain on the surgeon's wrist. .
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Affiliation(s)
- Joanna Bartnicka
- a Faculty of Organization and Management , Silesian University of Technology , Poland
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8
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Deng L, Xiong J, Xia Q. Single-incision versus conventional three-incision laparoscopic appendectomy: A meta-analysis of randomized controlled trials. J Evid Based Med 2017; 10:196-206. [PMID: 28276643 DOI: 10.1111/jebm.12238] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 11/06/2016] [Indexed: 02/05/2023]
Abstract
BACKGROUND Conventional three-incision laparoscopic appendectomy (CTLA) is considered the new golden standard for the treatment of acute appendicitis. However, single-incision laparoscopic appendectomy (SILA) can further reduce the number of abdominal incisions and visible scars. METHODS Major databases were researched for randomized clinical trials (RCTs) comparing SILA and CTLA for acute appendicitis from January 1983 and to March 2015. The technical feasibility, effectiveness, and safety between SILA and CTLA were compared. Pooled odds ratios (ORs) and weighted mean differences (WMDs) with 95% confidence intervals (CIs) were calculated using fixed- or random-effects models. RESULTS In total, 11 RCTs with 1489 patients were analyzed. The patients in the SILA group had a significantly shorter hospital duration (WMD: -0.63; 95% CI: -1.04, -0.21; P = 0.003) and return to activity (WMD: -2.91; 95% CI: -5.45, -0.37; P = 0.02) but experienced a longer operating time (WMD: 6.56; 95% CI: 3.55, 9.58; P < 0.0001) and higher rate of conversion (OR: 6.82; 95% CI: 3.14, 14.79; P < 0.00001). There were no differences between the two groups in visual analog pain scores, doses of analgesics, overall complication rates, wound infection, or cosmesis (all P > 0.05). CONCLUSIONS SILA is a safer and more effective than CTLA in both pediatric and adult patients.
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Affiliation(s)
- Lihui Deng
- Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Junjie Xiong
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qing Xia
- Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Hamill JK, Rahiri JL, Gunaratna G, Hill AG. Interventions to optimize recovery after laparoscopic appendectomy: a scoping review. Surg Endosc 2017; 31:2357-2365. [PMID: 27752812 DOI: 10.1007/s00464-016-5274-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 10/03/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND No enhanced recovery after surgery protocol has been published for laparoscopic appendectomy. This was a review of evidence-based interventions that could optimize recovery after appendectomy. METHODS Interventions for the review Clinical pathway, fast-track or enhanced recovery protocols; needlescopic approach; single incision laparoscopic (SIL) approach; natural orifice transluminal endoscopic surgery (NOTES); regional nerve blocks; intraperitoneal local anaesthetic (IPLA); drains. Data sources MEDLINE, EMBASE, the Cochrane Library, and the Web of Science Core Collection. Study eligibility criteria Randomized controlled trial (RCT); prospective evaluation with historical controls for studies assessing clinical pathways/protocols. Participants People undergoing laparoscopic appendectomy for acute appendicitis. Study appraisal and synthesis methods Meta-analysis, random effects model. RESULTS Clinical pathways for laparoscopic appendectomy were safe in selected patients, but may be associated with a higher readmission rate. Needlescopic surgery offered no recovery advantage over traditional laparoscopic appendectomy. SIL afforded no recovery advantage over conventional laparoscopic surgery, but may increase operative time in children. The search found no RCT on NOTES appendectomy. Transversus abdominis plane blocks did not significantly reduce pain after laparoscopic appendectomy. IPLA should be considered in laparoscopic appendectomy; studies in paediatric surgery are needed. The search found no RCT on the use of drains in appendectomy. CONCLUSIONS This review identified gaps in the literature on optimizing recovery after laparoscopic appendectomy and found the need for more randomized controlled trials on regional anaesthesia and intraperitoneal local anaesthesia in children.
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Affiliation(s)
- James K Hamill
- Department of Surgery, Starship Hospital, Park Road, Grafton, Private Bag 92024, Auckland, 1142, New Zealand.
- Department of Surgery, The University of Auckland, Auckland, New Zealand.
| | - Jamie-Lee Rahiri
- Department of Surgery, South Auckland Clinical Campus, The University of Auckland, Middlemore Hospital, Otahuhu, Auckland, New Zealand
| | - Gamage Gunaratna
- School of Medicine, The University of Auckland, Auckland, New Zealand
| | - Andrew G Hill
- Department of Surgery, The University of Auckland, Auckland, New Zealand
- Department of Surgery, South Auckland Clinical Campus, The University of Auckland, Middlemore Hospital, Otahuhu, Auckland, New Zealand
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10
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Clerveus M, Morandeira-Rivas A, Moreno-Sanz C, Herrero-Bogajo ML, Picazo-Yeste JS, Tadeo-Ruiz G. Systematic review and meta-analysis of randomized controlled trials comparing single incision versus conventional laparoscopic appendectomy. World J Surg 2015; 38:1937-46. [PMID: 24682257 DOI: 10.1007/s00268-014-2535-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Single incision laparoscopic appendectomy (SILA) has been proposed as an alternative to conventional laparoscopic appendectomy (CLA). OBJECTIVE The aim of this study was to evaluate the safety and efficacy of SILA when compared with CLA through a systematic review. METHODS We performed an electronic search of EMBASE, PubMed, MEDLINE, and Cochrane Central Register of Controlled Trials. Randomized controlled trials (RCTs) that compared SILA with CLA were included. RESULTS Six RCTs met eligibility criteria, which included a total of 800 patients, 401 in the SILA group and 399 in the CLA group. There were no significant differences in terms of overall complications (odds ratio [OR] 0.93; 95% confidence interval [CI] 0.59-1.47; p = 0.77). SILA had a higher technical failure rate (OR 3.30; 95% CI 1.26-8.65; p = 0.01) and required a longer operative time (mean difference [MD] 4.67; 95% CI 1.76-7.57; p = 0.002). SILA was associated with better cosmetic results (standardized MD -0.4; 95% CI -0.64 to -0.16; p = 0.001) and earlier return to normal activity (MD -0.64; 95% CI -1.09 to -0.20; p = 0.005), although these advantages should be taken with caution due to the small number of studies reporting these two items and the short follow-up in the evaluation of cosmetic results. There were no significant differences in terms of postoperative pain or length of hospital stay between groups. CONCLUSIONS SILA is comparable to CLA in selected patients, although it is associated with a higher technical failure rate and longer operative time. Further randomized trials are needed to determine if SILA really offers benefits over CLA.
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Affiliation(s)
- Michael Clerveus
- Department of Surgery, "La Mancha Centro" General Hospital, Avd. de la Constitución nº 3. 13600, Alcázar de San Juan, Ciudad Real, Spain,
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11
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Concha JAM, Cartes-Velásquez R, Delgado CM. Single-incision laparoscopic appendectomy versus conventional laparoscopy in adults. A systematic review. Acta Cir Bras 2015; 29:826-31. [PMID: 25517497 DOI: 10.1590/s0102-86502014001900010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 11/21/2014] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To determine the best treatment option for not complicated acute appendicitis (AA) in adult patients, between single incision laparoscopy (SIL) and conventional laparoscopy (CL), measured by morbidity associated with disease. METHODS Systematic review. Articles of adults diagnosed with AA treated by SIL or CL were analyzed. Databases included: MEDLINE, LILACS, IBECS, Web of Science, Scopus and Cochrane, using MeSH terms and free words. The studies were analyzed using the MINCIR methodology. Variables included: conversion rate, morbidity, hospital stay, surgery duration, and methodological quality (MQ) of primary studies. Averages, medians and weighted averages were calculated. RESULTS Thirteen articles were analyzed. For SIL and CL the conversion rate were 3.4% and 0.7 %, the morbidity were 8% and 6.5%, the hospital stay were 2.5 and 2.8 days, the surgery duration were 53.4 and 53.8 minutes, and the MQ were 14.3±6.6 and 16.0±6.9 points, respectively. CONCLUSION With the exception of the conversion rate, there are no differences between single incision laparoscopy and conventional laparoscopy for the treatment of acute appendicitis in adults.
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12
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Zhao L, Liao Z, Feng S, Wu P, Chen G. Single-incision versus conventional laparoscopic appendicectomy in children: a systematic review and meta-analysis. Pediatr Surg Int 2015; 31:347-53. [PMID: 25667049 DOI: 10.1007/s00383-015-3680-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/03/2015] [Indexed: 01/26/2023]
Abstract
PURPOSE Single-incision laparoscopic appendectomy (SILA) has been considered as an alternative to conventional laparoscopic appendectomy (CLA). The aim of this systematic review and meta-analysis was to compare clinical outcomes between single-incision laparoscopic appendicectomy and conventional laparoscopic appendicectomy in children. METHODS An electronic search of EMBASE, PubMed, MEDLINE was performed. Operative time, length of hospital stay, postoperative complications including wound infection, intra-abdominal infection, ileus in SILA and CLA were pooled and compared by meta-analysis. RESULTS Twelve studies (4 randomized controlled trials, 1 prospective study and 7 retrospective studies) that included 2,109 pediatric patients were studied. Of these patients, 933 and 1,176 patients had undergone SILA and CLA, respectively. There was significant shorter length of hospital stay for SILA compared with CLA in children; however, pooling the results for SILA and CLA revealed no significant difference in operative time and postoperative complications. CONCLUSION Compared with CLA, SILA has the advantage of shorter hospital stay. However, SILA failed to show any obvious advantages over CLA in operative time and postoperative complications including wound infection, intra-abdominal infection, and ileus.
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Affiliation(s)
- Lingling Zhao
- Department of Pathology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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Wang Y, Xiong W, Lan X, Zhang J, Chen T, Liu H, Li G. Suprapubic single incision laparoscopic appendectomy. J Surg Res 2015; 193:577-582. [PMID: 25179807 DOI: 10.1016/j.jss.2014.07.064] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 07/14/2014] [Accepted: 07/30/2014] [Indexed: 12/15/2022]
Abstract
BACKGROUND The single incision method through the umbilicus is commonly used for laparoscopic appendectomy. To obtain a better cosmetic outcome and less surgical complexity, we have designed a new single-incision laparoscopic appendectomy technique performed above the pubic symphysis. METHODS Between January 2011 and January 2012, patients with uncomplicated acute or chronic appendicitis, excluding those with abscess, perforation, peritonitis, and previous pelvic surgery, underwent this innovative laparoscopic appendectomy. During each operation, a multichannel trocar composed of a small wound protector and a size 6 sterile glove was deployed after a 2 cm transverse incision was made 1-2 cm above the pubic hair area. RESULTS Of the 42 patients, 24 were male and 18 were female. Their mean age was 30 ± 11 y. The mean operative time was 58 ± 11 min, mean time to first flatus postoperatively was 17 ± 8 h, and mean postoperative length of hospital stay was 3 ± 1 d. No complications occurred during surgery. No patient required conversion to either multiport or open appendectomy. Postoperative wound inflammation was observed in one case (2.3%). CONCLUSIONS Our results suggested that suprapubic single-incision laparoscopic appendectomy seems to be safe and feasible for selected patients, in consideration of cosmetic outcomes.
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Affiliation(s)
- Yanan Wang
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Wenjun Xiong
- Guangdong Province Hospital of Chinese Medicine, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiaoliang Lan
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jianming Zhang
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Tao Chen
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Hao Liu
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Guoxin Li
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China.
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14
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Corker HP, Singh P, Sodergren MH, Balaji S, Kwasnicki RM, Darzi AW, Paraskeva P. A randomized controlled study to establish the effect of articulating instruments on performance in single-incision laparoscopic surgery. JOURNAL OF SURGICAL EDUCATION 2015; 72:1-7. [PMID: 25218370 DOI: 10.1016/j.jsurg.2014.08.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 08/06/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE In single-incision laparoscopic surgery (SILS), operating through 1 incision presents ergonomic challenges. No consensus exists on whether articulating instruments (ARTs) may help. This study evaluated their effect on simulated SILS, hypothesizing that they would affect performance and workload. DESIGN Surgeons were randomized to 2 straight instruments (STRs), 1 ART and 1 STR, or 2 ARTs. After baseline testing, 25 repetitions of the Fundamentals of Laparoscopic Surgery (FLS) peg-transfer (PEG) task and 5 repetitions of the short-hand for the FLS pattern-cutting task (CIRCLE) were performed. Primary outcomes were maximum FLS PEG scores, CIRCLE times and errors, and Imperial College Surgical Assessment Device hand motion analysis. National Aeronautics and Space Administration (NASA) Raw Task Load Index (RTLX) questionnaires evaluated a secondary outcome--workload. SETTING The trial took place in a simulated operating theater within the Academic Surgical Unit at St Mary's Hospital, London, UK. PARTICIPANTS Eligible surgeons had completed at least 5 laparoscopic cases as a primary operator. Surgeons were stratified by laparoscopic experience into intermediate (less than 25 previous procedures as primary operator) or advanced (25 procedures or more). A total of 21 surgeons were recruited and randomized; 7 of them to each instrument combination group. All surgeons completed PEG, and 5 from each group completed CIRCLE. RESULTS Groups' baseline PEG scores were similar (p = 0.625). STR-ART achieved higher maximum PEG scores than STR or ART did (median = 236 vs 198 vs 193, respectively, p = 0.002). Fastest CIRCLE times were similar (median = 190s vs 130s vs 186s, p = 0.129) as were minimum errors (median = 1 vs 2 vs 3, p = 0.101). For PEG, Imperial College Surgical Assessment Device demonstrated similar total path lengths (median = 12.3m vs 12.3m vs 16.0m, p = 0.545) and total numbers of movements (median = 89.6 vs 86.4 vs 171, p = 0.080). Groups' NASA Raw Task Load Index scores were similar (p = 0.708). CONCLUSIONS Combining 1 STR and 1 ART improved SILS performance in the PEG task. Therefore, this may be the optimum instrument configuration for use within some clinical SILS applications.
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Affiliation(s)
- Harry P Corker
- Division of Surgery, Department of Surgery and Cancer, St Mary's Hospital, Imperial College London, London, United Kingdom
| | - Pritam Singh
- Division of Surgery, Department of Surgery and Cancer, St Mary's Hospital, Imperial College London, London, United Kingdom
| | - Mikael H Sodergren
- Division of Surgery, Department of Surgery and Cancer, St Mary's Hospital, Imperial College London, London, United Kingdom.
| | - Sathyan Balaji
- Division of Surgery, Department of Surgery and Cancer, St Mary's Hospital, Imperial College London, London, United Kingdom
| | - Richard M Kwasnicki
- Division of Surgery, Department of Surgery and Cancer, St Mary's Hospital, Imperial College London, London, United Kingdom
| | - Ara W Darzi
- Division of Surgery, Department of Surgery and Cancer, St Mary's Hospital, Imperial College London, London, United Kingdom
| | - Paraskevas Paraskeva
- Division of Surgery, Department of Surgery and Cancer, St Mary's Hospital, Imperial College London, London, United Kingdom
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Yao D, Wu S, Li Y, Chen Y, Yu X, Han J. Transumbilical single-incision laparoscopic distal pancreatectomy: preliminary experience and comparison to conventional multi-port laparoscopic surgery. BMC Surg 2014; 14:105. [PMID: 25494969 PMCID: PMC4277826 DOI: 10.1186/1471-2482-14-105] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 11/28/2014] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Single-incision laparoscopic surgery (SILS), which has been demonstrated to be safely applied on kinds of surgeries, may represent an improvement over conventional multi-port laparoscopic surgery. However, there are still few clinical experiences of SILS in pancreatic surgery until now. In this study, we will summarize our experience of transumbilical single-incision laparoscopic distal pancreatectomy (TUSI-LDP), and compare its related parameters with conventional multi-port laparoscopic distal pancreatectomy (C-LDP). METHODS A retrospective analysis was conducted for the patients who underwent C-LDP or TUSI-LDP in our department. The demographic data, operative parameters, and postoperative complications in the two groups were summarized and compared. RESULTS Laparoscopic distal pancreatectomy was performed in a total of 21 cases, among which TUSI-LDP was performed in 14 cases. As far as the demographical results concerned, there were no significant differences between the two groups. The conversion to open surgery was conducted in one case in the TUSI-LDP group because of severe adhesion between pancreatic cyst and surrounding tissues, while in the C-LDP group the only one conversion was for the difficult detection of small lesion. The mean operating time and intraoperative blood loss in TUSI-LDP group was a little shorter (166.4 ± 57.4 versus 202.1 ± 122.5 minutes, p > 0.05, and 157.1 ± 162.4 versus 168.6 ± 157.4 ml, p > 0.05). The postoperative pain and post-operation lengths of hospital stay in the TUSI-LDP group were also less, though there was no significant statistical difference between the two groups. For the post-operation complications, in TUSI-LDP group the pancreatic leakage occurred in only one case, and ceased spontaneously with only a drain for 61 days. There were no other complications including postoperative hemorrhage, venous thrombosis, infections and so on in both groups. CONCLUSION For the experienced laparoscopic surgeons, in selected patients, TUSI-LDP is a feasible technique, with excellent cosmetic effect, less postoperative pain and post-operation lengths of hospital stay. With the experience accumulated, the operating time and intraoperative blood loss of TUSI-LDP could also gradually reduce.
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Affiliation(s)
| | - Shuodong Wu
- Department of General Surgery, Shengjing Hospital, China Medical University, Shenyang 110004, China.
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Zhang DZ, Cai H, Wang XP, Chen Q, Zhang HJ. Effectiveness and safety of single-incision vs conventional three-port laparoscopic appendectomy: A meta-analysis. Shijie Huaren Xiaohua Zazhi 2014; 22:4862-4871. [DOI: 10.11569/wcjd.v22.i31.4862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the safety and clinical effectiveness of single-incision laparoscopic appendectomy (SILA).
METHODS: We electronically searched The Cochrane Library (Issue 5, 2014), EMbase, PubMed, China Academic Journal, Chinese Science and Technology Journal Full-text database, Chinese Biomedical Literature Database, VIP and Wanfang Data until June 1, 2014. Randomized controlled trials (RCTs) describing SILA and conventional three-port laparoscopic appendectomy (CTLA) were included. The quality of included studies was assessed and analyzed using RevMan 5 software (version 5.2).
RESULTS: A total of 12 RCTs involving 1577 patients were included. Meta-analysis indicated that compared with CTLA, there were significant differences in cosmetic result score (SMD = 0.52, 95%CI: 0.21-0.83, P = 0.001) and operative time (MD = 7.10, 95%CI: 4.31-9.89, P < 0.00001) in the SILA group. However, no differences were found in postoperative pain score (VAS), postoperative complications, postoperative abdominal abscess and hospital stay between the two groups.
CONCLUSION: SILA is a safe and effective technique for the treatment of uncomplicated benign appendix disease, and it has certain advantages over the CTLA.
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Raakow J, Liesaus HG, Neuhaus P, Raakow R. Single-incision versus multiport laparoscopic appendectomy: a case-matched comparative analysis. Surg Endosc 2014; 29:1530-6. [PMID: 25294525 DOI: 10.1007/s00464-014-3837-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 08/15/2014] [Indexed: 01/07/2023]
Abstract
BACKGROUND The multiport technique is the gold standard for laparoscopic appendectomy, but the use of single-incision laparoscopy is on the increase. The aim of the present study was to compare case-matched cohorts of patients who had undergone single-incision laparoscopic appendectomy (SILA) with those who had undergone conventional multiport laparoscopic appendectomy (MLA). METHODS In a case-matched analysis, all single-incision laparoscopic appendectomies performed between July 2009 and December 2013 at one institution were reviewed and compared to multiport laparoscopic appendectomies performed during the same period. Patients who had undergone SILA were matched in terms of age, gender, body mass index (BMI), and American Society of Anesthesiologists (ASA) scores with the same number of patients who had undergone MLA. Statistical evaluation included the description and comparison of demographic factors, details of surgery, and histological data. A univariate analysis was performed to assess potential risk factors for morbidity after SILA. RESULTS One hundred and fifty-six patients who had undergone SILA were reviewed, matched, and compared to the same number of patients who had undergone MLA. No significant difference was noted in mean operating times (50.83 vs. 50.61 min for SILA and MLA, respectively; p = 0.924) and the length of hospital stay (3.60 vs. 3.66 days; p = 0.704). No patient in either group required conversion to the open procedure while 6 (3.8 %) SILA patients were converted to multiport laparoscopy. SILA was not associated with significantly higher postoperative morbidity compared to MLA (9.6 % vs. 5.8 %; p = 0.288). Postoperative wound infection rates were higher after SILA (3.2 % vs. 0.6 %), but did not achieve statistical significance (p = 0.214). Statistical analysis revealed no risk factors for developing postoperative complications after the single-incision procedure. CONCLUSION SILA is a technically feasible and safe alternative to conventional MLA. The two procedures did not differ in terms of operating times, length of hospital stay, and postoperative outcomes.
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Affiliation(s)
- Jonas Raakow
- Department of General, Visceral and Transplantation Surgery, Universitätsmedizin Berlin, Charité Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany,
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Riggle JD, Miller EE, McCrory B, Meitl A, Lim E, Hallbeck MS, LaGrange CA. Ergonomic comparison of laparoscopic hand instruments in a single site surgery simulator with novices. MINIM INVASIV THER 2014; 24:68-76. [PMID: 25142199 DOI: 10.3109/13645706.2014.946426] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Single-site surgery improves cosmesis but increases procedural difficulty. Enhanced instruments could improve procedural efficiency leading to better patient outcomes. MATERIAL AND METHODS One pair of non-articulating (straight) and two different pairs of articulating laparoscopic instruments were evaluated using a peg-transfer surgical task simulator by premedical college students. The instruments were comparatively tested using task performance measures, ergonomic measures, and participant questionnaires. RESULTS The straight instrument produced significantly higher task performance scores and lower task times compared to both articulating instruments (p < 0.05). The straight instrument required less muscle activation and less wrist deviation than the articulating instruments to perform the same task. Participants rated the straight instrument significantly easier to use and less difficult to complete the task than with either articulating instrument (p < 0.05 for both). CONCLUSIONS This exploratory study suggests that novices have difficulty using articulating instruments and perform better using straight laparoscopic instruments when first attempting LESS surgical tasks. Although a study with post-graduate medical trainees is needed to confirm these results, trainees should initially practice LESS with non-articulating instruments to gain proficiency at basic laparoscopic tasks. Additionally, redesigning articulating instruments to specifically address the spatial constraints and learning curve of LESS may also improve trainee performance and instrument usability.
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Single-incision versus three-port laparoscopic appendectomy for acute appendicitis: systematic review and meta-analysis of randomized controlled trials. Surg Endosc 2014; 29:822-43. [PMID: 25106718 DOI: 10.1007/s00464-014-3735-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 07/08/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Three-port laparoscopic appendectomy (TPLA) has been shown superior to open appendectomy for acute appendicitis (AA); alternatively, single-incision laparoscopic appendectomy (SILA) is gaining popularity. The choice between SILA and traditional TPLA remains controversial. This meta-analysis of high-quality randomized controlled trials (RCTs) aims to compare efficacy and safety of SILA with TPLA for AA. METHODS We searched MEDLINE, EMBASE, and the Cochrane Library for RCTs comparing SILA with TPLA. Reference lists of relevant articles and reviews, conference proceedings, and ongoing trial databases were also searched. Primary outcomes were operative time, postoperative complications, hospital duration, and days back to normal activities. Meta-analysis was conducted where possible comparing items using weighted mean differences (WMDs) and relative risks (RRs) according to type of data. Methodological quality was evaluated to assess bias risk. RESULTS A total of 8 distinct RCTs comparing SILA (n = 616) with TPLA (n = 618) published from 2010 to 2013 were identified in our analysis. SILA took longer to conduct than TPLA (43 vs 38, WMD: 5.96, 95 % CI 2.54-9.38, P = 0.0006). Patients undergoing SILA needed more extra trocars addressed during operation (7 % vs 0 %, RR: 12.36, 95 % CI 3.83-39.90, P < 0.0001), but could return to full activities earlier (6 vs 7, WMD: -0.68, 95 % CI -1.10 to -0.26, P = 0.001). However, these differences were not clinically significant. All other parameters were comparable. CONCLUSIONS These results provide level 1a support for the clinical similarity that SILA is basically as feasible, effective and safe as TPLA when dealing with AA, although statistically, SILA takes longer to perform, requires more extra trocars, and benefits patients with faster recovery compared with TPLA. Further RCTs are needed to update our finding with advancement of surgical techniques and skills.
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McCrory B, LaGrange CA, Hallbeck M. Quality and safety of minimally invasive surgery: past, present, and future. Biomed Eng Comput Biol 2014; 6:1-11. [PMID: 25288906 PMCID: PMC4147776 DOI: 10.4137/becb.s10967] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Revised: 03/17/2014] [Accepted: 03/18/2014] [Indexed: 12/14/2022] Open
Abstract
Adverse events because of medical errors are a leading cause of death in the United States (US) exceeding the mortality rates of motor vehicle accidents, breast cancer, and AIDS. Improvements can and should be made to reduce the rates of preventable surgical errors because they account for nearly half of all adverse events within hospitals. Although minimally invasive surgery (MIS) has proven patient benefits such as reduced postoperative pain and hospital stay, its operative environment imposes substantial physical and cognitive strain on the surgeon increasing the risk of error. To mitigate errors and protect patients, a multidisciplinary approach is needed to improve MIS. Clinical human factors, and biomedical engineering principles and methodologies can be used to develop and assess laparoscopic surgery instrumentation, practices, and procedures. First, the foundational understanding and the imperative to transform health care into a high-quality and safe system is discussed. Next, a generalized perspective is presented on the impact of the design and redesign of surgical technologies and processes on human performance. Finally, the future of this field and the research needed to further improve the quality and safety of MIS is discussed.
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Affiliation(s)
- Bernadette McCrory
- Mechanical and Materials Engineering Department, University of Nebraska, Lincoln, NE, USA
| | - Chad A LaGrange
- Division of Urologic Surgery, Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA
| | - Ms Hallbeck
- Mechanical and Materials Engineering Department, University of Nebraska, Lincoln, NE, USA. ; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Health Care Policy and Research Department, Mayo Clinic, Rochester, MN, USA
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Gorter RR, Heij HA, Eker HH, Kazemier G. Laparoscopic appendectomy: State of the art. Tailored approach to the application of laparoscopic appendectomy? Best Pract Res Clin Gastroenterol 2014; 28:211-24. [PMID: 24485267 DOI: 10.1016/j.bpg.2013.11.016] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 11/23/2013] [Indexed: 02/07/2023]
Abstract
Acute appendicitis is the most common surgical emergency in developed countries. The treatment of acute appendicitis is either open or laparoscopic appendectomy. The latter has gained wide acceptance in the past years, although the debate on the true merits of laparoscopic appendectomy is still on going. Some authors prefer this approach as the gold standard for all patients, but in our opinion a tailored approach is warranted for specific patient groups. In addition, a standardised guideline on the technical aspects is still lacking. In the current article, open versus laparoscopic appendectomy and several technical aspects, such as stump closure, appendix extraction and single incision are discussed laparoscopic appendectomy are being addressed. In the future perspectives we will briefly discuss the third 'newly' introduced antibiotic treatment.
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Affiliation(s)
- Ramon R Gorter
- Paediatric Surgical Centre of Amsterdam, Emma Children's Hospital AMC & VU University Medical Centre, De Boelelaan 1117, 1081HV Amsterdam, The Netherlands; Department of Surgery, Red Cross Hospital, Vondellaan13, 1942 LE Beverwijk, The Netherlands.
| | - Hugo A Heij
- Paediatric Surgical Centre of Amsterdam, Emma Children's Hospital AMC & VU University Medical Centre, De Boelelaan 1117, 1081HV Amsterdam, The Netherlands.
| | - Hasan H Eker
- Department of Surgery, Red Cross Hospital, Vondellaan13, 1942 LE Beverwijk, The Netherlands; Department of Surgery, VU University Medical Centre, De Boelelaan 1117, 1081HV Amsterdam, The Netherlands.
| | - Geert Kazemier
- Department of Surgery, VU University Medical Centre, De Boelelaan 1117, 1081HV Amsterdam, The Netherlands.
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Lee SE, Choi YS, Kim BG, Cha SJ, Park JM, Chang IT. Single port laparoscopic appendectomy in children using glove port and conventional rigid instruments. Ann Surg Treat Res 2014; 86:35-8. [PMID: 24761405 PMCID: PMC3994610 DOI: 10.4174/astr.2014.86.1.35] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Revised: 10/18/2013] [Accepted: 10/24/2013] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To further improve the advantages of minimally invasive surgery, single port laparoscopic techniques continue to be developed. We report our initial experience with single port laparoscopic appendectomy (SPLA) in children and compare its outcomes to those of conventional laparoscopic appendectomy (CLA). METHODS Clinical data were prospectively collected for SPLA cases performed at Chung-Ang University Hospital by a single surgeon between March 2011 and December 2011, including operative time, perioperative complications, conversion rate, and length of hospital stay. Each case of SPLA was performed using conventional laparoscopic instruments through Glove port placed into the single umbilical incision. To compare outcomes, a retrospective review was performed for those patients who underwent CLA between March 2010 and December 2010. RESULTS Thirty-one patients underwent SPLA and 114 patients underwent CLA. Mean age (10.5 years vs. 11.1 years, P = 0.43), weight (48.2 kg vs. 42.9 kg, P = 0.27), and operation time (41.8 minutes vs. 37.9 minutes, P = 0.190) were comparable between both groups. Mean hospital stay was longer for CLA group (2.6 days vs. 3.7 days, P = 0.013). There was no conversion to conventional laparoscopic surgery in SPLA group. In CLA group, there were nine complications (7.9%) with 3 cases of postoperative ileuses and 6 cases wound problems. There was one complication (3.2%) of umbilical surgical site infection in SPLA group (P = 0.325). CONCLUSION The results of this study demonstrated that SPLA using conventional laparoscopic instruments is technically feasible and safe in children. SPLA using conventional laparoscopic instruments might be popularized by eliminating the need for specially designed instruments.
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Affiliation(s)
- Seung Eun Lee
- Department of Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Yoo Shin Choi
- Department of Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Beom Gyu Kim
- Department of Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Seong-Jae Cha
- Department of Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Joong-Min Park
- Department of Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - In Taik Chang
- Department of Surgery, Chung-Ang University College of Medicine, Seoul, Korea
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24
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Ahn SR, Kang DB, Lee C, Park WC, Lee JK. Postoperative pain relief using wound infiltration with 0.5% bupivacaine in single-incision laparoscopic surgery for an appendectomy. Ann Coloproctol 2013; 29:238-42. [PMID: 24466538 PMCID: PMC3895547 DOI: 10.3393/ac.2013.29.6.238] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 10/03/2013] [Indexed: 01/06/2023] Open
Abstract
Purpose Recently, single-incision laparoscopic surgery (SILS) has been popular for minimally invasive surgery and cosmetic improvement. However, some papers have reported that SILS for an appendectomy (SILS-A) has had the more postoperative complaints of pain. We investigated postoperative pain relief using wound infiltration with 0.5% bupivacaine in SILS-A and compared the result with that for conventional SILS-A. Methods Between July 2010 and September 2012, 75 patients who underwent SILS-A were enrolled in this study. The patients were randomly assigned to two groups: conventional SILS-A group (C-SILS-A) or wound infiltrated with 0.5% bupivacaine in SILS-A group (W-SILS-A). Forty-five patients were in the C-SILS-A, and 30 patients were in the W-SILS-A. Patients with perforated appendicitis were excluded. The clinical outcomes were compared between the groups by using the verbal numerical rating scale (VNRS). Results Clinical outcomes were similar in both study groups except for the pain score. The W-SILS-A group showed significantly lower numbers of additional pain killers and lower VNRS scores 1, 6, and 12 hours after surgery than the C-SILS-A group. Conclusion W-SILS-A is a technically simple and effective method of reducing early postoperative pain. It may be applicable in SILS-A for pain control system.
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Affiliation(s)
- So Ra Ahn
- Department of Surgery, Digestive Disease Research Institute and Institute of Medical Science, Wonkwang University College of Medicine, Iksan, Korea
| | - Dong Baek Kang
- Department of Surgery, Digestive Disease Research Institute and Institute of Medical Science, Wonkwang University College of Medicine, Iksan, Korea
| | - Cheol Lee
- Department of Anesthesiology, Digestive Disease Research Institute and Institute of Medical Science, Wonkwang University College of Medicine, Iksan, Korea
| | - Won Cheol Park
- Department of Surgery, Digestive Disease Research Institute and Institute of Medical Science, Wonkwang University College of Medicine, Iksan, Korea
| | - Jeong Kyun Lee
- Department of Surgery, Digestive Disease Research Institute and Institute of Medical Science, Wonkwang University College of Medicine, Iksan, Korea
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Transumbilical single-incision laparoscopic appendectomy using conventional instruments: the single working channel technique. Surg Laparosc Endosc Percutan Tech 2013; 23:208-11. [PMID: 23579520 DOI: 10.1097/sle.0b013e3182827f5d] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND This study aimed to evaluate the feasibility, safety, and cosmetic results of a novel technique, transumbilical single-incision laparoscopic appendectomy (TSILA), using a single working channel with conventional instruments. PATIENTS AND METHODS The study enrolled 84 consecutive patients undergoing laparoscopic appendectomy for acute appendicitis. To test the advantages of TSILA on the management of patients with acute appendicitis, a prospective randomized clinical trial was conducted. Surgical outcomes such as operation time, complication, and hospital stay of 42 patients undergoing TSILA were analyzed and compared with those of 42 patients undergoing classic 3-port appendectomy. All patients received a follow-up visit for 3 to 12 months. RESULTS The study consisted of 42 patients undergoing TSILA and 42 patients undergoing classic 3-port laparoscopic appendectomy with an average age of 34.1 and 34.9 years, respectively. The mean operative time of TSILA did not show any difference when compared with the classic procedure (84.8 vs. 77.9 min, P=0.271). No operative complications occurred in patients undergoing TSILA, whereas 2 patients undergoing the classic procedure showed incisional infection. The average postoperative hospital stay was 2.7 days in the TSILA group and 2.9 days in the classic procedure group with no difference (P=0.316). At the follow-up visit, no patient showed any evidence of incisional hernia. The transumbilical incisions were visible minimally, and the cosmetic scores given by patients undergoing TSILA was higher than that given by patients undergoing the classic procedure (4.5 vs. 3.9, P<0.001). CONCLUSIONS The results of the study demonstrate that laparoscopic appendectomy can be achieved through a single umbilical incision and a single working channel using conventional instruments and that this approach is successful, safe, economic, and esthetic.
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Pure NOTES transvaginal appendectomy with gasless laparoscopy. J Surg Res 2013; 186:179-83. [PMID: 24095022 DOI: 10.1016/j.jss.2013.08.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2013] [Revised: 07/28/2013] [Accepted: 08/27/2013] [Indexed: 11/22/2022]
Abstract
BACKGROUND The vagina is the most widely used approach to natural orifice transluminal endoscopic surgery. However, a gas leak can significantly affect transvaginal operations during pneumoperitoneum laparoscopy. We tried to establish the proper technique for transvaginal appendectomy under gasless laparoscopy. MATERIALS AND METHODS Five patients with chronic appendicitis were selected to receive gasless laparoscopic transvaginal appendectomy with concurrent vaginal hysterectomy. An abdominal wall-lifting device was applied after removal of the uterus, and the appendix was removed transvaginally. Clinical data such as operative duration, bleeding volume, morbidity, and hospital stay duration were analyzed. RESULTS All procedures were performed successfully, without intraoperative or major postoperative complications. The appendectomy portion of the procedure took approximately 20-30 minutes, with minimal blood loss. All patients were discharged, scar-free, 3 d after surgery. CONCLUSIONS Transvaginal appendectomy with gasless laparoscopy after vaginal hysterectomy appears to be a feasible and safe modification of established techniques, with acceptable outcomes.
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Pan MX, Liang ZW, Cheng Y, Jiang ZS, Xu XP, Wang KH, Liu HY, Gao Y. Learning curve of transumbilical suture-suspension single-incision laparoscopic cholecystectomy. World J Gastroenterol 2013; 19:4786-4790. [PMID: 23922478 PMCID: PMC3732853 DOI: 10.3748/wjg.v19.i29.4786] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 06/15/2013] [Accepted: 06/20/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the learning curve of transumbilical suture-suspension single-incision laparoscopic cholecystectomy (SILC).
METHODS: The clinical data of 180 consecutive transumbilical suture-suspension SILCs performed by a team in our department during the period from August 2009 to March 2011 were retrospectively analyzed. Patients were divided into nine groups according to operation dates, and each group included 20 patients operated on consecutively in each time period. The surgical outcome was assessed by comparing operation time, blood loss during operation, and complications between groups in order to evaluate the improvement in technique.
RESULTS: A total of 180 SILCs were successfully performed by five doctors. The average operation time was 53.58 ± 30.08 min (range: 20.00-160.00 min) and average blood loss was 12.70 ± 11.60 mL (range: 0.00-100.00 mL). None of the patients were converted to laparotomy or multi-port laparoscopic cholecystectomy. There were no major complications such as hemorrhage or biliary system injury during surgery. Eight postoperative complications occurred mainly in the first three groups (n = 6), and included ecchymosis around the umbilical incision (n = 7) which resolved without special treatment, and one case of delayed bile leakage in group 8, which was treated by ultrasound-guided puncture and drainage. There were no differences in intraoperative blood loss, postoperative complications and length of postoperative hospital stay among the groups. Bonferroni’s test showed that the operation time in group 1 was significantly longer than that in the other groups (F = 7.257, P = 0.000). The majority of patients in each group were discharged within 2 d, with an average postoperative hospital stay of 1.9 ± 1.2 d.
CONCLUSION: Following scientific principles and standard procedures, a team experienced in multi-port laparoscopic cholecystectomy can master the technique of SILC after 20 cases.
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Uday SK, Bhargav PRK. SILACIG: A novel technique of single-incision laparoscopic appendicectomy based on institutional experience of 29 cases. J Minim Access Surg 2013; 9:76-9. [PMID: 23741113 PMCID: PMC3673578 DOI: 10.4103/0972-9941.110967] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION: More reports of single-incision laparoscopic appendectomy are appearing in literature as it is an improvement over multiport laparoscopy in further reducing the trauma to abdomen. But, most of techniques require expensive gadgets like commercial ports and manoeuverable instruments, which are not available at many centres. In this context, a feasibility study of our own operative technique of single-incision laparoscopic appendectomy with less expensive conventional instrumentation was conducted at a single centre. MATERIALS AND METHODS: This prospective study was carried out in tertiary care teaching institute of a semi-urban area in South India over a period of 1 year from March 2011 to February 2012. Twenty-nine patients of appendicitis were included in this study. Based on the principles of single-incision laparoscopy, we developed a glove port utilizing readily available operation theatre equipment. RESULTS: Mean operative time was 56±12 minutes. Mean age of subjects was 34±15 years. M: F ratio was 2:1. There was no significant perioperative morbidity or mortality. Mean follow-up period was 8 months. CONCLUSION: Our initial experience with this technique of single-incision laparoscopic appendectomy demonstrates its feasibility, safety at a very low cost.
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Affiliation(s)
- S K Uday
- Department of General Surgery, Mamata Medical College and Hospital (MMC/MGH), Khammam, India
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Single-incision versus conventional three-incision laparoscopic appendicectomy for appendicitis: a systematic review and meta-analysis. J Pediatr Surg 2013; 48:1088-98. [PMID: 23701788 DOI: 10.1016/j.jpedsurg.2013.01.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Revised: 01/17/2013] [Accepted: 01/19/2013] [Indexed: 12/15/2022]
Abstract
BACKGROUND This meta-analysis was designed to investigate the safety and efficacy of single-incision laparoscopic appendicectomy (SILA) and three-incision laparoscopic appendicectomy (TILA) in the treatment of appendicitis. MATERIALS AND METHODS Studies published since 1992 that compared SILA versus TILA in laparoscopic appendicectomy were collected. Data on operative parameters, postoperative recovery, postoperative pain and complications, and hospitalization costs for SILA and TILA were meta-analyzed using fixed-effect and random-effect models. RESULTS Seventeen studies (1 randomized controlled trial and 16 retrospective studies) that included 1809 patients were studied. Of these patients, 793 and 1016 had undergone SILA and TILA, respectively. There was significantly shorter length of hospital stay; however, there were evidently higher conversion rate, and perhaps higher surgical difficulty and hospitalization costs for SILA compared with TILA. Other outcome variables such as operative time, blood loss, time to first oral intake, postoperative pain and complications were not found to be statistically significant for either group. CONCLUSIONS Compared with TILA, SILA has the advantage of shorter hospital stay, and it can achieve comparable operative time, blood loss, postoperative recovery, postoperative pain and complications with TILA. The drawback is that SILA is associated with higher conversion rate, and perhaps higher surgical difficulty and hospitalization costs. Whether it can achieve improvement in cosmesis remains to be confirmed.
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Wray CJ, Kao LS, Millas SG, Tsao K, Ko TC. Acute appendicitis: controversies in diagnosis and management. Curr Probl Surg 2013; 50:54-86. [PMID: 23374326 DOI: 10.1067/j.cpsurg.2012.10.001] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Pisanu A, Porceddu G, Reccia I, Saba A, Uccheddu A. Meta-analysis of studies comparing single-incision laparoscopic appendectomy and conventional multiport laparoscopic appendectomy. J Surg Res 2013; 183:e49-59. [PMID: 23582760 DOI: 10.1016/j.jss.2013.03.038] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2012] [Revised: 02/14/2013] [Accepted: 03/13/2013] [Indexed: 12/14/2022]
Abstract
BACKGROUND There is no consensus that single-incision laparoscopic appendectomy (SILS-A) is on a par with conventional multiport laparoscopic appendectomy (CMLA). The aim of this meta-analysis was to assess feasibility, safety, and potential benefits of SILS-A when compared with CMLA. METHODS A literature search for studies comparing SILS-A and CMLA was performed. Studies were reviewed for the outcome of interest: patient characteristics, operative outcome, postoperative recovery, postoperative morbidity, patient satisfaction, and cosmetic results. RESULTS Thirteen studies comparing SILS-A and CMLA were reviewed: two prospective randomized trials, four prospective studies, and seven retrospective studies. Overall, 893 patients were operated on: by SILS-A in 402 cases (45.0%) versus 491 cases (55.0%) by CMLA. Patients in the SILS-A group were significantly younger than those in the CMLA group (31.2 versus 33.5 y). No other differences were found. Patient satisfaction score was impossible to meta-analyze. CONCLUSIONS Appendectomy via SILS-A may be considered as an alternative to CMLA. However, these results must be approached with caution as they are based on data from nonrandomized observational studies. The feasibility and safety of SILS-A must be mainly assessed for difficult clinical situations such as severe obesity, localized abscess, or diffuse peritonitis from a ruptured appendix in the setting of new prospective randomized trials.
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Affiliation(s)
- Adolfo Pisanu
- Department of Surgery, Clinica Chirurgica, University of Cagliari, Monserrato, Italy.
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Randomized prospective study to compare laparoscopic appendectomy versus umbilical single-incision appendectomy. Ann Surg 2013; 257:413-8. [PMID: 23386239 DOI: 10.1097/sla.0b013e318278d225] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION The use of single-incision laparoscopic surgery may represent an improvement over conventional laparoscopic surgery. In recent years, more and more articles have been published demonstrating the feasibility of this approach. Hence, for this reason, we present this randomized prospective study to compare the 2 techniques. METHODS Between September 2009 and December 2010, a total of 184 patients with a diagnosis of acute appendicitis and indicated for surgery were included in the study, of whom, 91 received an appendectomy via a single umbilical incision and 93 via conventional laparoscopy. The study protocol was approved by the ethical committee of the Virgen de la Arrixaca University Hospital (Murcia). The study was registered on ClinicalTrials.gov with inscription number NCT0151529. All the operations were performed by the same team of surgeons. RESULTS As far as the demographical results of the study population are concerned, there were no significant differences between the 2 groups for age, weight, sex, body mass index, and removed appendix type. Operating time was longer with the single-port approach: 38.13 ± 13.49 versus 32.12 ± 12.44 minutes (P = 0.02). Significant differences were observed for postoperative pain, which was measured on the visual analog scale, with less pain reported in the single-incision group: 2.76 ± 1.64 versus 3.78 ± 1.76 (P < 0.001). There were no significant differences between the 2 groups for early and late complications and lengths of hospital stay measured in postoperative hours. CONCLUSIONS The transumbilical single-port approach is seen as a feasible technique for performing appendectomy. It does not increase the rate of complications and represents a possible alternative to conventional laparoscopic appendectomy.
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Vidal Ó, Astudillo E, Valentini M, Ginestà C, García-Valdecasas JC, Fernandez-Cruz L. Single-incision transperitoneal laparoscopic left adrenalectomy. World J Surg 2012; 36:1395-9. [PMID: 22392358 DOI: 10.1007/s00268-012-1555-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Laparoscopic adrenalectomy via three or four trocars is a well-established procedure. This report describes the initial experience with single-incision laparoscopic surgery (SILS) using the transperitoneal approach for left adrenalectomy. METHODS Between April 2010 and August 2011, all consecutive patients with adrenal masses, including Conn's syndrome, Cushing's adenoma, and nonfunctional adrenal tumors, who agreed to undergo SILS adrenalectomy were included in a prospective study. The left 2.5-cm subcostal incision was the sole point of entry. Data of patients who underwent SILS adrenalectomy were compared with those from an uncontrolled group of patients who underwent conventional laparoscopic adrenalectomy during the same study period. RESULTS There were 20 patients in each study group (20 men, 20 women; mean age [SD] = 50 [6.5] years). SILS was successfully performed and none of the patients required conversion to an open procedure. In one case of SILS procedure, an additional lateral 5-mm port was needed for retraction of the kidney. The mean (SD) duration of the operation was 95 (20) min in the SILS group and 80 (8) min in the conventional laparoscopic adrenalectomy group (p = 0.052). There were no intraoperative or postoperative complications. There were no differences between the two study groups with respect to postoperative pain, number of patients who resumed oral intake within the first 24 h, final pathologic diagnosis, and length of hospital stay. CONCLUSION SILS left adrenalectomy is a technically feasible and safe procedure in carefully selected patients. The definitive clinical, aesthetic and functional advantages of this technique require further analysis.
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Affiliation(s)
- Óscar Vidal
- General and Endocrine Surgery Unit, Department of General and Digestive Surgery, Digestive Diseases and Metabolism Institute, Hospital Clínic i Provincial, Universitat de Barcelona, CIRBERHED, IDIBAPS, Villarroel 170, 08036 Barcelona, Spain.
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Gill RS, Shi X, Al-Adra DP, Birch DW, Karmali S. Single-incision appendectomy is comparable to conventional laparoscopic appendectomy: a systematic review and pooled analysis. Surg Laparosc Endosc Percutan Tech 2012; 22:319-27. [PMID: 22874680 DOI: 10.1097/sle.0b013e31824f2cf8] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE Acute appendicitis remains the common gastrointestinal emergency in adults. Single-incision laparoscopic appendectomy (SILA) has been proposed as the next evolution in minimally invasive surgery. SILA is postulated to reduce postoperative pain and enhance cosmesis, while effectively removing an inflamed appendix. However, the efficacy and benefits of SILA compared with conventional laparoscopic appendectomy (CLA) remain to be determined. Our objectives were to systematically review the literature comparing SILA with CLA for acute appendicitis and perform a pooled analysis on the efficacy of SILA. METHODS Published English-language manuscripts were considered for review inclusion. A comprehensive search of electronic databases (eg, MEDLINE, EMBASE, SCOPUS, BIOSIS Previews, and the Cochrane Library) using broad search terms was completed. All comparative studies were included if they incorporated adult patients undergoing appendectomy for acute appendicitis by SILA. The primary outcomes of interest were operative time and length of hospital stay. RESULTS From a total of 366 articles, 34 articles were identified. A total of 9 comparative studies were included for pooled analysis. There was no significant difference in operative time, length of stay, pain scores, and conversion or complication rates between SILA and CLA for acute appendicitis. CONCLUSIONS This systematic review and pooled analysis demonstrates that SILA is comparable to CLA for acute appendicitis in adults. However, this review identifies the need for randomized controlled trials to clarify the efficacy of SILA compared with CLA.
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Affiliation(s)
- Richdeep S Gill
- Department of Surgery, University of Alberta, Edmonton, AB Canada
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Single-port laparascopic cholecystectomy: scarless cholecystectomy. Minim Invasive Surg 2012; 2012:204380. [PMID: 22645675 PMCID: PMC3356709 DOI: 10.1155/2012/204380] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Accepted: 02/16/2012] [Indexed: 12/13/2022] Open
Abstract
Objective. Single-incision laparoscopic surgery is a new advanced technology to further minimize the invasiveness of laparoscopy through a single small incision hidden in the umbilicus. The objective is to describe short and long-term outcomes of SILS cholecystectomy. Methodology. Patients with gallbladder pathologies were unselectively enrolled and were prospectively studied between April 2009 and April 2010 and completed a post-operative follow-up for 12 months. Results. There were 22 women and 8 men. Mean age was 46 years. Twenty-one patients had biliary colic, seven had acute cholecystitis, one had gallbladder polyp, and another had resolving acute pancreatitis. Mean operative time was 104.3 ± 44 minutes. Mean BMI was 30.42 and the average pain score was 3.2 ± 1.1. One more port was inserted to help in finishing the procedure in one patient. There was no conversion to a standard laparoscopic or open technique. There was one post-operative bile collection from a missed cyctic duct of Luschka. Mean hospital stay was 1.2 days. Conclusion. Single-port laparoscopic cholecystectomy is feasible. Early conversion to a standard laparoscopic technique is advised to avoid serious complications. The procedure has an obvious cosmetic benefit. Additional prospective trials are necessary to define the benefits of single-port laparoscopic cholecystectomy.
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de Laveaga AE, McCrory B, LaGrange CA, Hallbeck MS. Evaluation of Instrument Dexterity and Static Resistance of Laparoendoscopic Single-Site (LESS) Surgical Ports. J Med Device 2012. [DOI: 10.1115/1.4006130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
There is a lack of data on instrument dexterity and interface resistance with respect to the emerging surgical technology of LESS ports. A comparative analysis was conducted to characterize the force to maneuver laparoscopic instruments at various working angles within three commercially available LESS ports. A novel test fixture was created where working angles of the instruments were systematically varied in both the horizontal and sagittal plane within synthetic skin and rigid inserts. Two standard 5-mm laparoscopic graspers and a 10-mm simulated laparoscope were inserted into the trocars of the SILS™, TriPort™ and GelPOINT™ LESS ports. The positions of the laparoscope and grasper (G1) were fixed, while the working instrument’s position (G2) was systematically varied to create a range-of-motion. The static force required to maintain a specific position for G2 was measured using a digital force gauge for that range-of-motion. The resistance created by each LESS port was most noticeable at greater separation angles. The GelPOINT™ provided the least resistance to instrument movement; while the TriPort™ required the greatest amount of force at all angular positions. The 15-mm skin interface yielded lower overall resistance for all ports compared to the 30-mm skin interface. Resistance created by each LESS port increased with greater angular separation. Increased thickness and rigidity of the abdominal wall resulted in greater static forces and reduced instrument range-of-motion for all surgical ports. LESS port design and geometry heavily influenced overall instrument range-of-motion, as well as the resistance found at extreme separation angles. Surgeons should consider the degree of instrument motion required specific to the procedure being performed when selecting a LESS port.
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Affiliation(s)
- Adam E. de Laveaga
- Department of Mechanical and Materials Engineering, University of Nebraska- Lincoln, Lincoln, NE, 68588
| | - Bernadette McCrory
- Department of Mechanical and Materials Engineering, University of Nebraska- Lincoln, Lincoln, NE, 68588
| | - Chad A. LaGrange
- Department of Surgery, Section of Urology, University of Nebraska Medical Center, Omaha, NE, 68198
| | - M. Susan Hallbeck
- Department of Mechanical and Materials Engineering, University of Nebraska- Lincoln, Lincoln, NE, 68588
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Schill MR, Varela JE, Frisella MM, Brunt LM. Comparison of laparoscopic skills performance between single-site access (SSA) devices and an independent-port SSA approach. Surg Endosc 2012; 26:714-21. [PMID: 21993938 PMCID: PMC4443803 DOI: 10.1007/s00464-011-1941-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Accepted: 09/11/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND This study compared the performance of validated laparoscopic tasks on four commercially available single-site-access (SSA) devices with the performance of those tasks on an independent-port (IP) SSA setup. METHODS A prospective, randomized comparison of laparoscopic skills performance on four access devices (ADs) (GelPOINT, SILS Port, SSL Access System, TriPort) and one IP-SSA setup was conducted. A laparoscopic trainer box was used to train 18 (2nd- to 4th-year) medical students, four surgical residents, and five attending surgeons to proficiency in multiport laparoscopy using four laparoscopic drills (i.e., peg transfer, bean drop, pattern cutting, extracorporeal suturing). Drills then were performed in random order on each IP-SSA and AD-SSA setup using straight laparoscopic instruments. Repetitions were timed and errors recorded. Data are presented as mean ± standard deviation. Statistical analysis was performed by two-way analysis of variance (ANOVA) with Tukey HSD post hoc tests. RESULTS The attending surgeons had significantly faster total task times than the residents or students (P < 0.001), but the difference between the residents and students was not significant. Pair-wise comparisons showed significantly faster total task times for the IP-SSA setup than for all four AD-SSAs within the student group only (P < 0.05). The total task times for the residents and attending surgeons showed a similar profile, but the differences were not significant. When the data for the three groups were combined, the total task time was less for the IP-SSA setup than for each of the four AD-SSA setups (P < 0.001). Similarly, the IP-SSA setup was significantly faster than three of the four AD-SSA setups for peg transfer, three of the four setups for pattern cutting, and two of the four setups for suturing. No significant differences in error rates between the IP-SSA and AD-SSA setups were detected. CONCLUSIONS Compared with an IP-SSA laparoscopic setup, AD-SSAs are associated with longer task performance times in a trainer box model, independently of the level of training. Task performance was similar across the different SSA devices.
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Affiliation(s)
- Matthew R Schill
- Department of Surgery and Institute for Minimally Invasive Surgery, Washington University School of Medicine, 660 S. Euclid Avenue, Campus Box 8109, St. Louis, MO 63110, USA.
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Kang DB, Lee SH, Lee SY, Oh JT, Park DE, Lee C, Choi DH, Park WC, Lee JK. Application of single incision laparoscopic surgery for appendectomy in children. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2012; 82:110-5. [PMID: 22347713 PMCID: PMC3278632 DOI: 10.4174/jkss.2012.82.2.110] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Revised: 10/13/2011] [Accepted: 11/07/2011] [Indexed: 01/06/2023]
Abstract
Purpose Recently, single incision laparoscopic surgery (SILS) has been popular in use with its progress studied for more minimally invasive surgery and cosmetic improvement. We investigated the feasibility and efficacy of SILS for appendectomy (SILS-A) in children and compare it with conventional laparoscopic appendectomy (C-LA). Methods We studied, retrospectively, adolescent patients who underwent C-LA or SILS-A. There were 25 patients in the C-LA group and 30 patients in the SILS-A group. The clinical outcomes were compared between the groups. Results The SILS-A procedures were performed successfully in adolescent patients . There were no significant difference between the C-LA and SILS-A group with respect to demographic data and post-operative outcomes. There was one complication (4%) in the C-LA group and two complications (6.6%) in the SILS-A group, but there was no significant difference. Conclusion SILS-A was technically feasible and safe in children. Considering little postoperative scar and no difference in post-operative outcomes compared to C-LA, SILA could be applicable in adolescent patients. Larger studies and further technical implements will be necessary to assess the true benefit of this approach.
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Affiliation(s)
- Dong Baek Kang
- Department of Surgery, Digestive Disease Research Institute and Institute of Medical Science, Wonkwang University College of Medicine, Iksan, Korea
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Greaves N, Nicholson J. Single incision laparoscopic surgery in general surgery: a review. Ann R Coll Surg Engl 2011; 93:437-40. [PMID: 21929912 PMCID: PMC3369327 DOI: 10.1308/003588411x590358] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2011] [Indexed: 01/07/2023] Open
Abstract
Single incision laparoscopic surgery (SILS) is a rapidly developing field that may represent the future of laparoscopic surgery. The major advantage of SILS over standard laparoscopic surgery is in cosmesis, with surgery becoming essentially scarless if the incision is hidden within the umbilicus. Only one incision is required so the risk of potential complications like port site hernias, haematomas and wound infection is reduced. The trade-off for this is a technically more challenging procedure with different underlying principles to that of traditional laparoscopic surgery. A wide variety of new equipment has been developed to support SILS and the range of procedures that are amenable to the technique is increasing. To date most of the published data relating to SILS are in the form of case series, with the first large randomised controlled trials due to be completed by the end of 2012. The existing evidence suggests that SILS is similar to standard laparoscopic surgery in terms of complication rates, completion rates and post-operative pain scores. However, the duration of SILS is longer than equivalent laparoscopic procedures. This article discusses SILS with regard to its applications in general surgery and reviews the evidence currently available.
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Vidal O, Valentini M, Ginestà C, Espert JJ, Martinez A, Benarroch G, Anglada MT, García-Valdecasas JC. Single-incision versus standard laparoscopic cholecystectomy: comparison of surgical outcomes from a single institution. J Laparoendosc Adv Surg Tech A 2011; 21:683-6. [PMID: 21774697 DOI: 10.1089/lap.2011.0047] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Laparoscopic cholecystectomy via the three-trocar technique is widely used for symptomatic gallbladder stones. Single-incision laparoscopic surgery (SILS) for cholecystectomy is a well-established procedure and represents the next step in developing the concept of mini-invasive surgery. We here described our 24-month experience SILS cholecystectomy. METHODS Between February 2009 and 2011, patients referred for cholecystectomy to the General and Endocrine Unit of our institution who agreed to undergo SILS were included in a prospective study. All operations were performed by the same surgical team specially trained in this type of surgery. The umbilicus was the sole point of entry for all patients. The same operative technique was used in all patients. Data of patients undergoing SILS cholecystectomy were compared with those from an uncontrolled group of patients undergoing standard laparoscopic cholecystectomy during the same study period. RESULTS The SILS and standard cholecystectomy groups included 120 patients each. SILS was performed in all patients and none of them required conversion to an open procedure. The median operating time of 45 minutes in the SILS group was not significantly different from that in the standard laparoscopic cholecystectomy group. We suture fascial edge with simple stitches under direct vision, thus reducing the risk of incisional hernia in SILS group (P=.046). CONCLUSIONS SILS cholecystectomy was technically feasible and safe and represents a reproducible alternative to standard laparoscopic cholecystectomy in selected patients. The definitive clinical, esthetic, and functional advantages of this technique require further analysis.
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Affiliation(s)
- Oscar Vidal
- General and Endocrine Surgery Unit, Department of Digestive Surgery, Digestive Diseases and Metabolism Institute, Hospital Clínic i Provincial, Universitat de Barcelona, IDIBAPS Barcelona, Spain.
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Bibliography. Female urology. Current world literature. Curr Opin Urol 2011; 21:343-6. [PMID: 21654401 DOI: 10.1097/mou.0b013e3283486a38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Zheng M, Qin M, Zhao H. Laparoendoscopic single-site cholecystectomy: a randomized controlled study. MINIM INVASIV THER 2011; 21:113-7. [PMID: 21574826 DOI: 10.3109/13645706.2011.577787] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This study reports the initial experience with laparoendoscopic single-site (LESS) cholecystectomy and compares it with laparoscopic cholecystectomy (LC) through a randomized controlled trial. Sixty selective patients diagnosed with cholelithiasis or polyp lesion of the gallbladder (PLG) were randomly divided into two groups undergoing either LESS cholecystectomy or LC separately. The clinical data about operations and recovery of the two groups were compared. In the LESS group 28 of 30 patients underwent LESS cholecystectomy successfully and the remaining two (6.7%) were converted to standard laparoscopic surgery. LC was successfully performed in all patients in the control group. Mean operative time of LESS cholecystectomy group and LC group was 55.6 ± 25.7 versus 42.7 ± 18.6 (p < 0.05). Mean postoperative hospital stay was 3.7 ± 1.3 versus 3.8 ± 0.8 days (p < 0.05). Mean pain index was 2.8 ± 0.6 versus 3.7 ± 1.1 (p < 0.05). A questionnaire revealed that the mean scores of satisfaction with the operation were 8.9 ± 0.7 versus 8.1 ± 1.5 (p < 0.05). LESS cholecystectomy is safe, feasible, minimally invasive, and cosmetic. It is a reasonable alternative to selective patients with uncomplicated cholelithiasis and PLG. But larger controlled studies are still needed.
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Bruna Esteban M, Mulas Fernández C, Puche Plá J, Roig Vila JV. [Single-port laparoscopic gastric resection for a gastric GIST]. Cir Esp 2011; 90:400-2. [PMID: 21481853 DOI: 10.1016/j.ciresp.2011.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Revised: 01/24/2011] [Accepted: 02/06/2011] [Indexed: 10/18/2022]
Affiliation(s)
- Marcos Bruna Esteban
- Servicio de Cirugía General y del Aparato Digestivo, Consorcio Hospital General Universitario de Valencia, España.
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Cox DR, Zeng W, Frisella MM, Brunt LM. Analysis of standard multiport versus single-site access for laparoscopic skills training. Surg Endosc 2011; 25:1238-44. [PMID: 20872019 PMCID: PMC4443802 DOI: 10.1007/s00464-010-1349-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2010] [Accepted: 08/17/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Single-site-access (SSA) laparoscopy is more challenging to perform than multiport (MP) laparoscopy. This study examined the effect of MP versus SSA skills training on laparoscopic performance using surgically naive medical students. METHODS For the study, 40 medical students at the end of their first year were randomized into two groups. Both groups were trained in four basic laparoscopic drills (peg, rope, bean drop, pattern cutting) using a standard MP setup (group 1) and an SSA approach (group 2). The time and number of repetitions required to attain proficiency were recorded. Each group then crossed over to the alternate approach and repeated the sequence. Data are presented as mean ± standard deviation, and statistical analysis was performed using the two-tailed, unpaired t test. RESULTS The total times required to attain proficiency for the SSA and MP approaches were not significantly different between the MP-trained group (234.0 ± 114.9 min) and the SSA-trained group (216.4 ± 106.5 min) (p = 0.67). The MP-trained group required less time to reach proficiency on the standard MP setup than the group using the SSA approach (119.1 ± 69.7 vs. 178.0 ± 93.4 min; p = 0.058) and significantly fewer repetitions (77.6 ± 42.6 vs. 118.8 ± 54.3; p = 0.027). The SSA-trained group required significantly less time to reach proficiency on the MP setup than the standard MP-trained group (38.4 ± 29.4 vs. 119.1 ± 69.7 min; p = 0.0013) and needed only a mean of 26.9 repetitions. When the standard MP trainees crossed over to the SSA setup, they required significantly less time to reach proficiency with the SSA approach than the SSA-trained group (114.8 ± 50.5 vs. 178.0 ± 93.4 min; p = 0.026) but required more repetitions than with the MP approach (86.2 ± 35.2 vs. 77.6 ± 42.6; nonsignificant difference). CONCLUSIONS Laparoscopic SSA skills training results in longer times and more repetitions to achieve proficiency than MP training, but the skills acquired transfer well to the MP approach.
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Affiliation(s)
- Daniel R Cox
- Department of Surgery and Institute for Minimally Invasive Surgery, Washington University School of Medicine, 660 S Euclid Avenue, Box 8109, St. Louis, MO 63110, USA
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Kang KC, Lee SY, Kang DB, Kim SH, Oh JT, Choi DH, Park WC, Lee JK. Application of single incision laparoscopic surgery for appendectomies in patients with complicated appendicitis. JOURNAL OF THE KOREAN SOCIETY OF COLOPROCTOLOGY 2010; 26:388-94. [PMID: 21221238 PMCID: PMC3017973 DOI: 10.3393/jksc.2010.26.6.388] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2010] [Accepted: 10/06/2010] [Indexed: 01/09/2023]
Abstract
Purpose Recently, single incision laparoscopic surgery (SILS) has been studied for its being less invasive surgery and having cosmetic improvement. We investigated the application of SILS for an appendectomy (SILS-A) in cases of complicated appendicitis and compare it with a conventional laparoscopic appendectomy (C-LA). Methods This study involved a total of 40 patients who underwent C-LA or SILS-A in patients with complicated appendicitis; 25 patients received a C-LA, and the other 15 patients received a SILS-A. The clinical outcomes and cosmetic results were compared between the groups. Results The SILS-A procedures were performed successfully in patients with complicated appendicitis, but 6 patients who underwent SILS-A needed an additional port for dissection and drainage. Clinical outcomes and postoperative complications were similar in both study groups. The SILS-A group showed significantly higher numbers of pain control than the C-LA group, and the one port SLLS-A group showed significantly better cosmetic result than the C-LA group. Conclusion SILS-A is technically feasible and safe in patients with complicated appendicitis. However, SILS-A has more postoperative pain than C-LA, and more active pain control should be considered for patients undergoing SILS-A.
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Affiliation(s)
- Kyung Chae Kang
- Department of Surgery, Digestive Disease Research Institute and Institute of Medical Science, Wonkwang University College of Medicine, Iksan, Korea
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Brown-Clerk B, de Laveaga AE, LaGrange CA, Wirth LM, Lowndes BR, Hallbeck MS. Laparoendoscopic single-site (LESS) surgery versus conventional laparoscopic surgery: comparison of surgical port performance in a surgical simulator with novices. Surg Endosc 2010; 25:2210-8. [PMID: 21184104 DOI: 10.1007/s00464-010-1524-x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2010] [Accepted: 12/02/2010] [Indexed: 02/06/2023]
Abstract
BACKGROUND Although laparoendoscopic single-site (LESS) surgery is feasible, it poses many technical challenges not seen in conventional laparoscopy. Recent interest and widespread implementation of LESS stems from advancements in commercially available access port technology. Consequently, this study objectively compared the technical performance between conventional laparoscopic and LESS surgical ports in a modified Fundamentals of Laparoscopic Surgery (FLS) simulator. METHODS The 24 novice participants in this study performed the FLS peg transfer task using two conventional laparoscopic 12-mm working ports, the SILS port, the TriPort access system, and the GelPOINT system with two standard length 5-mm graspers. Each participant completed the task using conventional laparoscopy first for familiarization, followed by each of the three LESS surgical ports in random order. Task completion time, errors, and subjective questionnaire ratings were used to compare conventional laparoscopy and the single-port devices. Congruent with FLS scoring procedures, task completion time and errors were used to compute a standardized task score for each port. RESULTS The task score did not differ significantly between conventional laparoscopy and the single-port devices. Additionally, there were no task score differences between trials for either the SILS port or the GelPOINT system. There was a significant performance decrement starting with the TriPort versus starting with either the SILS port or the GelPOINT, which resulted in the lowest overall trial task score (p<0.05). Task completion difficulty and instrument maneuverability resulted in no significant differences between ports. Ease of use and overall rank were significant, with conventional laparoscopy rated as the easiest to use and the highest overall followed by the GelPOINT system. CONCLUSIONS Overall, the TriPort may be more challenging for novices to use in learning the LESS procedure than either the SILS port or the GelPOINT system. The GelPOINT system may offer the most consistent platform for LESS performance and novice skill acquisition.
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Affiliation(s)
- Bernadette Brown-Clerk
- Department of Industrial and Management Systems Engineering, Industrial and Management Systems Engineering, University of Nebraska-Lincoln, 348B Nebraska Hall, Lincoln, NE 68588-0518, USA
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Chiu CG, Nguyen NH, Bloom SW. Single-incision laparoscopic appendectomy using conventional instruments: an initial experience using a novel technique. Surg Endosc 2010; 25:1153-9. [PMID: 20927545 DOI: 10.1007/s00464-010-1332-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2010] [Accepted: 08/17/2010] [Indexed: 12/11/2022]
Abstract
BACKGROUND Laparoscopic appendectomy has gained wide acceptance. This study aimed to evaluate the feasibility, safety, and cosmetic results of a novel technique: single incision laparoscopic (SIL) appendectomy. METHODS The study enrolled consecutive patients undergoing appendectomy for acute appendicitis. Appendectomy was performed using three trocars and conventional laparoscopic instruments through a single small umbilical incision (length, ~3 cm). The patients received standard pre- and postoperative care and presented for a follow-up visit after a mean of 27 days. RESULTS The study cohort consisted of 26 patients (10 women and 16 men) with an average age of 44 years (range, 13-83 years). Of 26 appendectomies, 22 (85%) were achieved through a single surgical site. The mean SIL appendectomy operative time was 58 min (range, 33-107 min). No operative complications occurred. The average postoperative hospital stay was 1.2 days for nonperforated appendicitis and 2.7 days for perforated appendicitis. At the follow-up visit, no patient showed any evidence of incisional hernia. The operative incisions were minimally visible, and all the individuals reported a highly favorable cosmetic outcome. CONCLUSIONS The results of the study demonstrated that laparoscopic appendectomy can be achieved through a single umbilical incision using conventional instruments and that this approach is successful, safe, and aesthetic.
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Affiliation(s)
- Connie G Chiu
- Department of Surgery, The Richmond Hospital, University of British Columbia, 910 West 10th Avenue, Room 3100, Vancouver, BC V5Z 4E3, Canada.
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Dapri G, Casali L, Dumont H, Van der Goot L, Herrandou L, Pastijn E, Sosnowski M, Himpens J, Cadière GB. Single-access transumbilical laparoscopic appendectomy and cholecystectomy using new curved reusable instruments: a pilot feasibility study. Surg Endosc 2010; 25:1325-32. [PMID: 20809190 DOI: 10.1007/s00464-010-1304-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2010] [Accepted: 07/21/2010] [Indexed: 01/02/2023]
Abstract
BACKGROUND The umbilicus can be considered as the embryological opening for single-access laparoscopic procedures. We report on single-access transumbilical laparoscopic appendectomy (SATLA) and cholecystectomy (SATLC), performed using new curved reusable instruments. PATIENTS AND METHODS A retrospective review of a prospectively maintained database of 30 patients who underwent SATLA and 20 patients who underwent SATLC between May and November 2009 was undertaken. All procedures were performed with an 11-mm nondisposable trocar for the scope, and curved reusable instruments (Karl Storz-Endoskope, Tuttlingen, Germany) placed transumbilically without trocars. Outcome measures were conversion to standard laparoscopy, operative time, scar length, complications, hospital stay, and use of pain medication. RESULTS All SATLA patients had acute appendicitis, and SATLC patients had symptomatic gallstones (15), chronic cholecystitis (3), and acute cholecystitis (2). No extraumbilical trocars were necessary. Mean total operative times were 57.3 ± 15.9 min (SATLA) and 73.9 ± 20.1 min (SATLC). Mean laparoscopic times were 39 ± 13.1 min (SATLA) and 57.5 ± 18.9 min (SATLC). Mean scar lengths were 14.8 ± 2.2 mm (SATLA) and 15.8 ± 2.3 mm (SATLC). Five SATLA patients and one SATLC patient developed postoperative complications. Mean hospital stay was 2.9 ± 1.3 days for SATLA patients and 1.8 ± 0.8 days for SATLC patients. Pain medication used was minimal. At the minimum follow-up of 3 months no late complications were registered. CONCLUSIONS SATLA and SATLC can be performed safely using curved reusable instruments, which helps avoid the conflict between the surgeon's hands or between the instruments' tips and allows the surgeon to operate in an ergonomic position. The reusable instruments kept the cost similar to that of classic laparoscopy.
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Affiliation(s)
- Giovanni Dapri
- Department of Gastrointestinal Surgery, European School of Laparoscopic Surgery, Saint-Pierre University Hospital, 322, Rue Haute, 1000 Brussels, Belgium.
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Lee JA, Sung KY, Lee JH, Lee DS. Laparoscopic appendectomy with a single incision in a single institute. JOURNAL OF THE KOREAN SOCIETY OF COLOPROCTOLOGY 2010; 26:260-4. [PMID: 21152227 PMCID: PMC2998004 DOI: 10.3393/jksc.2010.26.4.260] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2010] [Accepted: 07/09/2010] [Indexed: 01/04/2023]
Abstract
Purpose The laparoscopic appendectomy has become popular for the treatment of acute appendicitis. A single-incision laparoscopic appendectomy offers better cosmesis. We present the results of single-incision laparoscopic appendectomies in our hospital as initial experience. Methods A single-incision laparoscopic appendectomy was performed in 75 patients at The Catholic University of Korea, Bucheon St. Mary's hospital. The operating time, operation type, hospital stay, surgical morbidities, and body mass index were compared. Results This retrospective study revealed equal operation times in both the suppurative and the perforated appendicitis group. There was an increase in the hospital stay in the perforated appendicitis group. The postoperative complication rate was 4%, and the median operation time was 58.55 ± 31.79 minutes. Conclusion The single-incision laparoscopic appendectomy was easy and safe procedure for treating acute appendicitis. There were no differences in degree of inflammation and body mass index.
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Affiliation(s)
- Jin A Lee
- Department of Surgery, The Catholic University of Korea School of Medicine, Seoul, Korea
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Vidal Ó, Ginestà C, Valentini M, Martí J, Benarroch G, García-Valdecasas JC. Suprapubic single-incision laparoscopic appendectomy: a nonvisible-scar surgical option. Surg Endosc 2010; 25:1019-23. [PMID: 20737172 DOI: 10.1007/s00464-010-1307-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2010] [Accepted: 07/24/2010] [Indexed: 10/19/2022]
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