Comparison of postoperative pain after needle grasper-assisted single-incision laparoscopic appendectomy versus single-incision laparoscopic appendectomy: a prospective randomized controlled trial (PANASILA trial)

Abstract

Purpose This study was performed to compare the efficacies of newly developed needle grasper-assisted (Endo Relief) single-incision laparoscopic appendectomy (NASILA) and single-incision laparoscopic appendectomy (SILA). Methods This study enrolled 110 patients with acute appendicitis without periappendiceal abscess, diagnosed using computed tomography, who were randomized to the SILA (n = 54) and NASILA groups (n = 56) between December 2017 and August 2018 (6 patients withdrawn). The NASILA technique entailed a small umbilical incision for the glove port (equivalent to that for a 12-mm trocar), and a 2.5-mm suprapubic incision for the needle grasper. Results The SILA and NASILA groups included 49 (male, 61.2%) and 55 (male, 54.5%) patients, respectively. Age, body mass index, abdominal surgical history, symptom duration, and use of patient-controlled analgesia did not differ significantly between the 2 groups. The main wound size was significantly smaller in the NASILA group than in the SILA group (1.8 ± 0.4 cm vs. 2.2 ± 0.4 cm, P < 0.001). The operative time and estimated blood loss did not differ significantly between both groups. The immediate postoperative pain score, i.e., the primary endpoint, was significantly lower in the NASILA group than in the SILA group (2.33 ± 0.98 vs. 2.82 ± 1.29, P = 0.031). The complaints for scar status 1 month postoperatively did not differ significantly between the groups. Conclusion NASILA could attenuate postoperative pain by minimizing the size of the surgical wound; further, NASILA may not be inferior to SILA in terms of cosmetic results.

Laparoscopic Appendectomy Using the Surgical-Glove Port Through an Umbilical Incision: A Single-Center Retrospective Study

“…An extension of the umbilical incision may help prevent surgical site infections in patients with this umbilical morphology [ 26 ]. Many randomized controlled trials comparing SILA and TLA have shown similar surgical outcomes regarding operative time, length of hospital stay, and postoperative complications [ 4 , 5 , 8 , 12 ].…”

“…However, the difference in pain between SILA and TLA remains debatable. According to some studies, SILA is more painful than TLA, particularly during exertion and coughing [ 8 , 12 ]. Thus, numerous studies have revealed no difference in pain scores between the two procedures [ 1 , 5 ].…”

“…The use of these devices in SILA may lead to an increase in healthcare expenses. Numerous authors have developed their own SILA devices [ 1 , 3 , 7 , 10 - 12 ].…”

A brief overview of single-port laparoscopic appendectomy as an optimal surgical procedure for patients with acute appendicitis: still a long way to go

“…Finally, 17 research articles or case series on SPLA, from the Republic of Korea, China, India, Spain, and other countries, were included in the present review. [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] Most articles were from the Republic of Korea (n ¼ 6), followed by China (n ¼ 4), India (n ¼ 3), Vietnam (n ¼ 1), Argentina (n ¼ 1), Egypt (n ¼ 1), and Spain (n ¼ 1). There were eight retrospective studies, six prospective studies, and three case series (Figure 1).…”

“…Surgical techniques, equipment, and devices, including magnet-assisted single trocar (MAST), needle grasper (Endo Relief)-assisted single-incision laparoscopic appendectomy (NASILA), and SPLA using a needle-type grasping forceps (SLAN) are summarized (Table 1). [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] The performance of each technique was also compared in terms of clinical outcomes (Table 2).…”