American Surgical Association

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Single Incision Versus Standard 3-port Laparoscopic Appendectomy: A Prospective Randomized Trial
Shawn D St. Peter, MD*, Daniel J Ostlie, MD*, Susan W Sharp, MD*, Obinna O. Adibe, MD*, David Juang, MD*, Carissa L Garey, MD*, Carrie A Laituri, MD*, Charles L Snyder, MD*, Walter S Andrews, MD*, Ronald J Sharp, MD*, J Patrick Murphy, MD*, George W Holcomb, III , MD
Children's Mercy Hospital, Kansas City, MO

OBJECTIVE(S): Laparoscopy through a single umbilical incision is an emerging technique supported by several case series, but prospective comparative data are lacking. Therefore, we conducted a prospective, randomized trial comparing single site umbilical laparoscopic appendectomy to 3-port laparoscopic appendectomy.
METHODS: After IRB approval, patients were randomized to laparoscopic appendectomy via a single umbilical incision or standard 3-port access. The primary outcome variable was postoperative wound infection. With a power of 0.9 and an alpha of 0.05, 180 patients were calculated for each arm. Patients with perforated appendicitis were excluded. The technique of ligation/division of the appendix and mesoappendix was left to the surgeon’s discretion. There were 7 participating surgeons dictated by the call schedule. All patients received the same pre-operative antibiotics and post-operative management was controlled.
RESULTS: From 8/2009 through 11/2010, 360 patients were enrolled. There were no differences in patient characteristics (Table 1). Operative time and hospital charges were less with the standard 3-port approach, but there was no difference in wound infection rate (Table 2).
CONCLUSIONS: The single umbilical incision approach to appendectomy produces longer operative times resulting in greater charges. However, these small differences are likely of marginal clinical relevance.
Table 1 - Patient Characteristics at Operation
Single Incision (N=180)3-Port (N=180)P Value
Age (yrs)11.05 +/- 3.4711.04 +/- 3.410.98
Weight (kg)42.7 +/- 18.542.5 +/- 17.40.90
Gender (% male)54.4%51.1%0.53
Leukocyte count14.7 +/- 5.214.6 +/- 5.40.89

Table 2 - Outcome Data
Single Incision (N=180)3-Port (N=180)P Value
Wound Infection3.3%1.7%0.50
Operative Time (mins)35.2 +/- 14.529.8 +/- 11.6<0.001
Post-Op Length of Stay (hours)22.7 +/- 6.222.2 +/- 6.80.44
Hospital Charges ($)17.6K +/- 4.0K16.5 +/- 3.8K0.005


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