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.
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 |
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 |
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