Single-Incision Two-Port Laparoscopic Surgery as A Substitute for Single-Port Trans-umbilical Laparoscopic Surgery: Patients who Underwent Laparoscopic Appendectomy Surgery

Safari, MH

Single-Incision Two-Port Laparoscopic Surgery as A Substitute for Single-Port Trans-umbilical Laparoscopic Surgery: Patients who Underwent Laparoscopic Appendectomy Surgery

Document Type : Original Article

Author

MH Safari

Researcher of General Surgery, Office of Applied Research, Kermanshah, Iran

Abstract

Introduction & Objective: Laparoscopic management of diseases has now been accepted as a golden standard in international societies. However, there are still many studies on the newest methods of minimally invasive surgery in order to achieve the best surgical procedure with the most favorable post-operative outcomes. The purpose of this study was to compare the results of postoperative outcomes of single-port trans-umbilical laparoscopic appendectomy and single-incision two-port laparoscopic appendectomy. Materials & Methods: In this retrospective study, 77 patients participated who underwent single-port trans-umbilical laparoscopic appendectomy and single-incision two-port laparoscopic appendectomy during one year (May 2017-2018). In single-incision two-port laparoscopic appendectomy group, two 5-mm trocars were implanted in a trans-umbilically, and another hole was used for left-hand instruments. Demographic specifications, operation data, and post-operative results of groups were compared using Chi-squared test or, if necessary, Fisher test. The T-test was used to compare the average of the two target groups that were independent of each other. The significance level of the tests was considered to be 0.05. Statistical analyses were performed using the SAS EG 5.1 server, version 9.3. (SAS Institute Inc., Cary, NC, USA) Results: The total average time of single-incision two-port laparoscopic appendectomy surgery was significantly lower than that of single-port trans-umbilical laparoscopic appendectomy (P = 0.003). The average laparoscopic time was significantly lower in the single-incision two-port laparoscopic appendectomy group (P < 0.001). The average number of postoperative analgesic drugs in the single-incision two-port laparoscopic appendectomy group was significantly lower than that of single-port trans-umbilical laparoscopic appendectomy (p = 0.002). The average number of hospitalization post-operative days in the single-incision two-port laparoscopic appendectomy was significantly lower than that of single-port trans-umbilical laparoscopic appendectomy group (P = 0.008). No other statistically significant difference was observed between the two groups. Conclusions: According to the findings of this study, the average number of duration of the single-incision two-port laparoscopic appendectomy was significantly lesser and thus required less pain management; also, in aesthetic point of view, its result was similar to that of single-port trans-umbilical laparoscopic appendectomy.

Keywords

Appendectomy

Laparoscopic Surgery

Operation Duration

Residency Education

1. Bhangu A, Soreide K, Di Saverio S, Assarsson JH, Drake FT. Acute appendicitis: modern understanding of pathogenesis, diagnosis, and management. Lancet 2015; 386: 1278-1287.

2. Li X, Zhang J, Sang L, et al. Laparoscopic versus conventional appendectomy - a meta-analysis of randomized controlled trials. BMC Gastroenterology 2010; 10: 129.

3. Yau KK, Siu WT, Tang CN, Yang GP, Li MK. Laparoscopic versus open appendectomy for complicated appendicitis. J Am Coll Surg 2007; 205: 60-65.

4. Panait L, Bell RL, Duffy AJ, Roberts KE. Two-port laparoscopic appendectomy: minimizing the minimally invasive approach. J Surg Res 2009; 153: 167-171.

5. Frutos MD, Abrisqueta J, Lujan J, Abellan I, Parrilla P. Randomized prospective study to compare laparoscopic appendectomy versus umbilical
single-incision appendectomy. Ann Surg 2013; 257: 413-418.

6. Hong TH, Kim HL, Lee YS, et al. Trans-umbilical single-port laparoscopic appendectomy (TUSPLA): scarless intracorporeal appendectomy. J Laparoendosc Adv Surg Tech A 2009; 19: 75-78.

7. Lee J, Baek J, Kim W. Laparoscopic Trans-umbilical single-port appendectomy: initial experience and comparison with three-port appendectomy. Surg Laparosc Endosc Percutan Tech 2010; 20: 100-103.

8. St Peter SD, Adibe OO, Juang D, et al. Single incision versus stan- dard 3-port laparoscopic appendectomy: a prospective randomized trial. Ann Surg 2011; 254: 586-590.

9. Cai YL, Xiong XZ, Wu SJ, et al. Single-incision laparoscopic appendectomy vs conventional laparoscopic appendectomy: systematic review and meta-analysis. World J Gastroenterol 2013; 19:
5165-5173.

10. Chow A, Purkayastha S, Nehme J, Darzi LA, Paraskeva P. Single incision laparoscopic surgery for appendicectomy: a retrospective comparative analysis. Surg Endosc 2010; 24: 2567-2574.

11. Donmez T, Hut A, Avaroglu H, et al. Two-port laparoscopic appendectomy assisted with needle grasper comparison with conventional laparoscopic appendectomy. Ann Surg Treat Res 2016; 91: 59-65.

12. Olijnyk JG, Pretto GG, da Costa Filho OP, Machado FK, Silva Chalub SR, Cavazzola LT.
Two-port laparoscopic appendectomy as transition to laparoendoscopic single site surgery. J Minim
Access Surg 2014; 10: 23-26.

13. Pattanshetti VM, Krishna KL. Conventional laparoscopic appendectomy versus double-incision, three-port laparoscopic appendectomy: A 1-year randomized controlled trial. Asian J Endosc Surg 2018 Feb 19 [Epub]. DOI: 10.1111/ases. 12467.

14. Gomes CA, Sartelli M, Di Saverio S, et al. Acute appendicitis: proposal of a new comprehensive grading system based on clinical, imaging and laparoscopic findings. World J Emerg Surg 2015; 10: 60.

15. Udwadia TE. Single-incision laparoscopic surgery: An overview. J Minim Access Surg 2011; 7: 1-2.

16. Switzer NJ, Gill RS, Karmali S. The evolution of the appendectomy: from open to laparoscopic to single incision. Scientifica (Cairo) 2012; 2012: 895469.

17. Kim HO, Yoo CH, Lee SR, et al. Pain after laparoscopic appendectomy: a comparison of
Trans-umbilical single-port and conventional laparoscopic surgery. J Korean Surg Soc 2012; 82: 172-178.

18. Lee CH, Jeon WJ, Youn SJ, et al. The experience of Trans-umbilical endoscopic appendectomies. Ann Surg Treat Res 2014; 86: 278-282.

19. Lee JS, Choi YI, Lim SH, Hong TH.
Trans-umbilical single port laparoscopic appendectomy using basic equipment: a comparison with the three ports method. J Korean Surg Soc 2012; 83: 212-217.

20. Rammohan A, Jothishankar P, Manimaran AB, Naidu RM. Two- port vs. three-port laparoscopic appendicectomy: A bridge to least invasive surgery. J Minim Access Surg 2012; 8: 140-144.

21. Lin YY, Shabbir A, So JB. Laparoscopic appendectomy by residents: evaluating outcomes and learning curve. Surg Endosc 2010; 24: 125-130.

22. Carter JT, Kaplan JA, Nguyen JN, Lin MY, Rogers SJ, Harris HW. A prospective, randomized controlled trial of single-incision laparoscopic vs conventional 3-port laparoscopic appendectomy for treatment of acute appendicitis. J Am Coll Surg 2014; 218:
950-959.

23. Teoh AY, Chiu PW, Wong TC, et al. A
double-blinded random- ized controlled trial of laparoendoscopic single-site access versus conventional 3-port appendectomy. Ann Surg 2012; 256: 909-914.

24. Lee WS, Choi ST, Lee JN, et al. Single-port laparoscopic appendectomy versus conventional laparoscopic appendectomy: a prospective randomized controlled study. Ann Surg 2013; 257: 214-218.

25. Bhatia P, Sabharwal V, Kalhan S, John S, Deed JS, Khetan M. Single-incision multi-port laparoscopic appendectomy: How I do it. J Minim Access Surg 2011; 7: 28-32.

26. Morita Y, Yamaguchi S, Ishii T, et al. Does
Trans-umbilical incision increase incisional hernia at the extraction site of laparoscopic anterior resection? Am J Surg 2015; 209: 1048-1052.

27. Tsuji Y, Maeda K, Ono S, Yanagisawa S, Baba K,

Usui Y. A new paradigm of scarless abdominal surgery in children: Trans-umbilical minimal incision surgery. J Pediatr Surg 2014; 49: 1605-1609.

28. Yamamoto M, Tanaka K, Asakuma M, et al. Does

Trans-umbilical Incision Influence Surgical Site Infection Rates of the Laparoscopic Sigmoidectomy and Anterior Resection? Am Surg 2015; 81:
1232-1236.