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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 +/- 3.47	11.04 +/- 3.41	0.98
Weight (kg)	42.7 +/- 18.5	42.5 +/- 17.4	0.90
Gender (% male)	54.4%	51.1%	0.53
Leukocyte count	14.7 +/- 5.2	14.6 +/- 5.4	0.89

Table 2 - Outcome Data

	Single Incision (N=180)	3-Port (N=180)	P Value
Wound Infection	3.3%	1.7%	0.50
Operative Time (mins)	35.2 +/- 14.5	29.8 +/- 11.6	<0.001
Post-Op Length of Stay (hours)	22.7 +/- 6.2	22.2 +/- 6.8	0.44
Hospital Charges ($)	17.6K +/- 4.0K	16.5 +/- 3.8K	0.005