Laparoscopic Versus Umbilical Single-Incision Appendectomy
Laparoscopic Versus Umbilical Single-Incision Appendectomy
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.
Laparoscopic appendectomy has rapidly developed in recent years. Since Semm published the first complete removal of the appendix via laparoscopic surgery in 1983 and Schreiber performed the first laparoscopic appendectomy in a patient with acute appendicitis in 1987, laparoscopic appendectomy has been included in practically all hospitals worldwide as the usual procedure in emergency departments.
Laparoscopic appendectomy has several advantages over the open approach, such as less surgical trauma, a better postoperative recovery, exploration of the entire abdominal cavity (especially in obese patients and women at a fertile age), management of unexpected findings, a quick return to normal patient activity, and a better cosmetic outcome.
The tendency toward reduced patient morbidity after surgery has enabled the development of techniques requiring an increasingly less invasive access to the operating field. Over the last decade, surgeons in a bid to be less invasive and provide greater comfort to patients, have developed means of access to the abdominal cavity with less surgical trauma such as natural-orifice transluminal endoscopic surgery and single-incision laparoscopic surgery.
The use of single-incision laparoscopic surgery may represent an improvement over conventional laparoscopic surgery. With the number of incisions reduced to 1 umbilical incision, the potential advantages would be a better cosmetic outcome, less postoperative pain due to nonpenetration of the muscle, and avoidance of possible hemorrhagic complications from injury to the epigastric vessels. In recent years, more and more articles have been published demonstrating the feasibility of this approach in different pathologies, although the great majority do not include large series or randomized prospective studies. In the field of evidence-based medicine, we are currently obliged to conduct randomized prospective studies to compare the 2 techniques.
Abstract and Introduction
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.
Introduction
Laparoscopic appendectomy has rapidly developed in recent years. Since Semm published the first complete removal of the appendix via laparoscopic surgery in 1983 and Schreiber performed the first laparoscopic appendectomy in a patient with acute appendicitis in 1987, laparoscopic appendectomy has been included in practically all hospitals worldwide as the usual procedure in emergency departments.
Laparoscopic appendectomy has several advantages over the open approach, such as less surgical trauma, a better postoperative recovery, exploration of the entire abdominal cavity (especially in obese patients and women at a fertile age), management of unexpected findings, a quick return to normal patient activity, and a better cosmetic outcome.
The tendency toward reduced patient morbidity after surgery has enabled the development of techniques requiring an increasingly less invasive access to the operating field. Over the last decade, surgeons in a bid to be less invasive and provide greater comfort to patients, have developed means of access to the abdominal cavity with less surgical trauma such as natural-orifice transluminal endoscopic surgery and single-incision laparoscopic surgery.
The use of single-incision laparoscopic surgery may represent an improvement over conventional laparoscopic surgery. With the number of incisions reduced to 1 umbilical incision, the potential advantages would be a better cosmetic outcome, less postoperative pain due to nonpenetration of the muscle, and avoidance of possible hemorrhagic complications from injury to the epigastric vessels. In recent years, more and more articles have been published demonstrating the feasibility of this approach in different pathologies, although the great majority do not include large series or randomized prospective studies. In the field of evidence-based medicine, we are currently obliged to conduct randomized prospective studies to compare the 2 techniques.
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