Single-port laparoscopic appendectomy using a needle-type grasping forceps compared with conventional three-port laparoscopic appendectomy for patients with acute uncomplicated appendicitis: a single-center retrospective study

Abstract

Objective To compare the clinical outcomes between single-port laparoscopic appendectomy using a needle-type grasping forceps (SLAN) and conventional three-port laparoscopic appendectomy (CLA) for patients with uncomplicated appendicitis. Methods We retrospectively collected clinical data of patients with uncomplicated appendicitis who underwent SLAN or CLA from May 2019 to May 2021 in our center. The patients’ baseline characteristics, perioperative outcomes, and follow-up data were compared between the two groups. Additionally, baseline characteristics were compared with postoperative outcomes in the SLAN group. Results Ninety-six patients were enrolled (SLAN group, n = 32; CLA group, n = 64). The SLAN group had a shorter hospital stay, lower 24-hour postoperative visual analogue scale scores, shorter postoperative fasting time, lower frequency of antibiotic administration, and longer operative time than the CLA group. In the SLAN group, younger patients had a longer appendix and male patients had a thicker appendix; additionally, patients with an appendiceal diameter of 0.6 to 1.0 cm had a longer postoperative hospital stay and higher frequency of antibiotic administration. Conclusions Compared with CLA, SLAN may be less invasive, provide faster postoperative recovery, and result in better cosmesis for patients with uncomplicated appendicitis. Further research should be performed to evaluate the long-term outcomes.

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).…”

“…Traditional laparoscopic trocars have also been used by many teams. 18 , 22 , 26 – 29 Among them, both the single-incision laparoscopic appendectomy using conventional multiport laparoscopic instruments (SILACI), completed by Uday et al., 22 and the SLAN designed at the present authors’ centre (Chaoyang Central Hospital), 27 – 29 were completed using the traditional three-port laparoscopic instruments. Notably, SLAN showed a smaller mean incision length than SILACI (1 cm versus 2.5 cm), which may have been due to needle forceps used at Chaoyang Central Hospital to assist the operation, during which only two 5-mm trocars were required for entry, observation and operation.…”

“… 35 Considering the mild inflammatory status and uncomplicated surgical procedures, SPLA has frequently been performed in patients with uncomplicated appendicitis. 17 , 21 , 25 – 29 Conversely, patients with complicated appendicitis are at higher risk of conversion to laparotomy, for whom strict surgical indications should be adopted. 36 In cases where indwelling abdominal drainage tubes are required (e.g., for appendiceal perforation), the selection of single-port laparoscopic surgery becomes limited.…”

Single-incision laparoscopic appendectomy versus traditional three-hole laparoscopic appendectomy for acute appendicitis in children by senior pediatric surgeons: a multicenter study from China

“…The mirror technique is a concern for surgeons ( 20 ). Unfortunately, to date, SILA has not been widely recognized for the treatment of acute appendicitis in children ( 21 ). Compared with THLA, SILA requires that the spatial relationship between the operating forceps and the observation lens be considered, and the single-incision approach affects the surgeon's and assistant's range of motion, thereby complicating and prolonging the surgery ( 22 ).…”