Single-incision laparoscopic surgery in children: A randomized control trial of acute appendicitis

Eduardo Perez, Hannah Piper, Lorrie S. Burkhalter, Anne C. Fischer

Research output: Contribution to journalArticle

51 Citations (Scopus)

Abstract

Background: Single-incision laparoscopic surgery (SILS) is a novel area of minimally invasive surgery that uses a single incision to minimize all ports to one site. The end result is an incision that can be strategically placed in the umbilicus for a perceived scarless abdomen. The authors rationalized that a randomized controlled trial was important given the rapid popularization of this approach. Methods: An institutional review board-approved prospective randomized trial compared patients undergoing SILS (SILS-A) and conventional laparoscopic (LAP-A) appendectomy at a free-standing children's hospital during a median follow-up period of 2.2 years. Results: A total of 50 patients (50 % boys and 67 % Hispanics) were randomized equally to SILS-A and LAP-A. The patients ranged in age from 3 to 15 years without a difference between the two groups. Half (50 %) of these patients were younger than 8 years. The technique for SILS-A involved a single supraumbilical curvilinear skin incision with three fascial incisions. Ports were inserted to varying depths to minimize restriction of instrument movement. Coaxial visualization was improved by the use of a 30 scope. To achieve technical comparability with the LAP-A, a stapler device was used, which required upsizing a 5 mm port to a 12 mm port. The mean duration of the operation was 46.8 ± 3.7 min (range, 22-120 min) compared with 34.8 ± 2.5 min (range, 18-77 min) for standard LAP-A (p = 0.010). No conversions occurred, and the two groups did not differ in hospital length of stay. The postoperative complications consisted of one wound seroma in the SILS-A group (nonsignificant difference), and no hernias were seen. No difference in readmissions, diet tolerance, fever, or postoperative pain was noted between the two groups. Conclusions: The findings show the SILS approach to be feasible in the pediatric population despite the limited abdominal domain in younger children. Although SILS operating room times currently are longer than for LAP-A, they are comparable, and no other outcomes differed appreciably between the two techniques at the time of hospitalization or during the follow-up period.

Original languageEnglish
Pages (from-to)1367-1371
Number of pages5
JournalSurgical Endoscopy and Other Interventional Techniques
Volume27
Issue number4
DOIs
StatePublished - Apr 1 2013

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Appendicitis
Laparoscopy
Length of Stay
Umbilicus
Seroma
Appendectomy
Minimally Invasive Surgical Procedures
Research Ethics Committees
Operating Rooms
Hernia
Postoperative Pain
Hispanic Americans
Abdomen
Hospitalization
Fever
Randomized Controlled Trials
Pediatrics
Diet
Equipment and Supplies
Skin

Keywords

  • Appendectomy
  • Pediatric surgery
  • Single-access surgery
  • Single-incision laparoscopic surgery (SILS)

ASJC Scopus subject areas

  • Surgery

Cite this

Single-incision laparoscopic surgery in children : A randomized control trial of acute appendicitis. / Perez, Eduardo; Piper, Hannah; Burkhalter, Lorrie S.; Fischer, Anne C.

In: Surgical Endoscopy and Other Interventional Techniques, Vol. 27, No. 4, 01.04.2013, p. 1367-1371.

Research output: Contribution to journalArticle

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abstract = "Background: Single-incision laparoscopic surgery (SILS) is a novel area of minimally invasive surgery that uses a single incision to minimize all ports to one site. The end result is an incision that can be strategically placed in the umbilicus for a perceived scarless abdomen. The authors rationalized that a randomized controlled trial was important given the rapid popularization of this approach. Methods: An institutional review board-approved prospective randomized trial compared patients undergoing SILS (SILS-A) and conventional laparoscopic (LAP-A) appendectomy at a free-standing children's hospital during a median follow-up period of 2.2 years. Results: A total of 50 patients (50 {\%} boys and 67 {\%} Hispanics) were randomized equally to SILS-A and LAP-A. The patients ranged in age from 3 to 15 years without a difference between the two groups. Half (50 {\%}) of these patients were younger than 8 years. The technique for SILS-A involved a single supraumbilical curvilinear skin incision with three fascial incisions. Ports were inserted to varying depths to minimize restriction of instrument movement. Coaxial visualization was improved by the use of a 30 scope. To achieve technical comparability with the LAP-A, a stapler device was used, which required upsizing a 5 mm port to a 12 mm port. The mean duration of the operation was 46.8 ± 3.7 min (range, 22-120 min) compared with 34.8 ± 2.5 min (range, 18-77 min) for standard LAP-A (p = 0.010). No conversions occurred, and the two groups did not differ in hospital length of stay. The postoperative complications consisted of one wound seroma in the SILS-A group (nonsignificant difference), and no hernias were seen. No difference in readmissions, diet tolerance, fever, or postoperative pain was noted between the two groups. Conclusions: The findings show the SILS approach to be feasible in the pediatric population despite the limited abdominal domain in younger children. Although SILS operating room times currently are longer than for LAP-A, they are comparable, and no other outcomes differed appreciably between the two techniques at the time of hospitalization or during the follow-up period.",
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