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PALM DESERT, CALIF. – Single-incision laparoscopic surgical appendectomy is both feasible and safe across a wide range of pediatric patient ages, results from a single-center study showed.
"Single-incision laparoscopic surgery is an exciting area of minimally invasive surgery," Dr. Eduardo A. Perez said at the annual meeting of the American Pediatric Surgical Association. "There are known disadvantages, including limited lateral movement and dueling instruments, but industry is working hard to improve these platforms. This includes articulating instruments, flexible laparoscopes, multichannel ports, and robotic platforms."
Dr. Perez, of the division of pediatric surgery at Children’s Medical Center, Dallas, and his associates randomized 50 patients equally to either single-incision laparoscopic surgery (SILS) or conventional laparoscopy (LAP) for appendectomy and followed them for a median of 14 months. The technique for SILS involved a single supraumbilical curvilinear incision with three fascial incisions placed in a triangular fashion. To make SILS technically comparable to the LAP procedure, the researchers used a stapler device that required upsizing a 5-mm port to a 12-mm size. Cosmesis was not studied.
The children ranged in age from 3 to 15 years, and there were no significant age differences between the two treatment groups. Half of the patients were under age 8, 50% were male, and 67% were Hispanic.
The overall mean OR time was 46.8 minutes for the SILS procedure, compared with 34.8 minutes for the LAP procedure, a difference that was significant (P = .010). However, the OR time between groups became more similar as the number of cases increased. For example, after the first 25 patients were treated, the mean OR time for the SILS procedure was 49.3 minutes, compared with 33.5 minutes for the LAP procedure, a difference that remained significant (P = .049). After the last 25 patients were treated, the mean OR times were no longer significantly different between the two groups (a mean of 44.1 vs. 36 minutes, respectively).
There were no conversions and no differences in hospital length of stay between the two groups (a median of 40.3 hours for SILS vs. 36.7 hours for LAP).
The only complication was a wound seroma in the SILS group, and no hernias were observed. In addition, no differences were noted between the two groups in terms of hospital readmissions, diet tolerance, fever, or postoperative pain.
Operative times between SILS and LAP appendectomy "are similar once experience is gained," Dr. Perez concluded. "OR cost is similar when using standard instruments, but this will increase [in SILS] with the use of newer, more advanced instruments."
Dr. Perez said that he had no relevant financial disclosures to make.
The meeting was supported by a grant from Elsevier, which owns this news organization.
This study is one of several evaluating SILS vs. traditional three-port laparoscopy for appendectomy in children. Data reported at the American Surgical Association annual meeting in April by researchers from Children’s Mercy Hospital in Kansas City showed that SILS took longer, was more costly (presumably because of a stapler), and required more use of analgesics. SILS patients also had a trend toward higher wound infection, and although it was not statistically significant, the surgeons switched to an extracorporeal appendectomy through the umbilical site in an attempt to reduce that rate. In a total of 10% of the cases that started out as SILS, surgeons had to convert to three-port laparoscopy because of the degree of difficulty in performing SILS. However, there were no conversions to open surgery.
In the current study, OR time was significantly longer with SILS than with conventional laparoscopy. The researchers did not evaluate cosmesis – supposedly the only advantage of SILS. Their cost analysis is lacking, although they suspect that with newer technology to make SILS easier to perform, the cost will go up.
It’s interesting that there were no conversions. Does that mean no conversions from SILS to using additional ports and still doing it laparoscopically, or no conversions to an open procedure?
The jury is still out about the benefits of SILS. It is technically feasible, but is it any better than traditional three-port laparoscopy? I suspect that the concept of better cosmesis will eventually drive public demand for the procedure. Vanity is a powerful influence in our society.
Dr. Jay L. Grosfeld is the Lafayette F. Page Professor Emeritus of Pediatric Surgery, Indiana University, Indianapolis. He stated that he had no disclosures.
Dr. Eduardo A. Perez, American Pediatric Surgical Association, SILS, LAP, supraumbilical curvilinear incision,
This study is one of several evaluating SILS vs. traditional three-port laparoscopy for appendectomy in children. Data reported at the American Surgical Association annual meeting in April by researchers from Children’s Mercy Hospital in Kansas City showed that SILS took longer, was more costly (presumably because of a stapler), and required more use of analgesics. SILS patients also had a trend toward higher wound infection, and although it was not statistically significant, the surgeons switched to an extracorporeal appendectomy through the umbilical site in an attempt to reduce that rate. In a total of 10% of the cases that started out as SILS, surgeons had to convert to three-port laparoscopy because of the degree of difficulty in performing SILS. However, there were no conversions to open surgery.
In the current study, OR time was significantly longer with SILS than with conventional laparoscopy. The researchers did not evaluate cosmesis – supposedly the only advantage of SILS. Their cost analysis is lacking, although they suspect that with newer technology to make SILS easier to perform, the cost will go up.
It’s interesting that there were no conversions. Does that mean no conversions from SILS to using additional ports and still doing it laparoscopically, or no conversions to an open procedure?
The jury is still out about the benefits of SILS. It is technically feasible, but is it any better than traditional three-port laparoscopy? I suspect that the concept of better cosmesis will eventually drive public demand for the procedure. Vanity is a powerful influence in our society.
Dr. Jay L. Grosfeld is the Lafayette F. Page Professor Emeritus of Pediatric Surgery, Indiana University, Indianapolis. He stated that he had no disclosures.
This study is one of several evaluating SILS vs. traditional three-port laparoscopy for appendectomy in children. Data reported at the American Surgical Association annual meeting in April by researchers from Children’s Mercy Hospital in Kansas City showed that SILS took longer, was more costly (presumably because of a stapler), and required more use of analgesics. SILS patients also had a trend toward higher wound infection, and although it was not statistically significant, the surgeons switched to an extracorporeal appendectomy through the umbilical site in an attempt to reduce that rate. In a total of 10% of the cases that started out as SILS, surgeons had to convert to three-port laparoscopy because of the degree of difficulty in performing SILS. However, there were no conversions to open surgery.
In the current study, OR time was significantly longer with SILS than with conventional laparoscopy. The researchers did not evaluate cosmesis – supposedly the only advantage of SILS. Their cost analysis is lacking, although they suspect that with newer technology to make SILS easier to perform, the cost will go up.
It’s interesting that there were no conversions. Does that mean no conversions from SILS to using additional ports and still doing it laparoscopically, or no conversions to an open procedure?
The jury is still out about the benefits of SILS. It is technically feasible, but is it any better than traditional three-port laparoscopy? I suspect that the concept of better cosmesis will eventually drive public demand for the procedure. Vanity is a powerful influence in our society.
Dr. Jay L. Grosfeld is the Lafayette F. Page Professor Emeritus of Pediatric Surgery, Indiana University, Indianapolis. He stated that he had no disclosures.
PALM DESERT, CALIF. – Single-incision laparoscopic surgical appendectomy is both feasible and safe across a wide range of pediatric patient ages, results from a single-center study showed.
"Single-incision laparoscopic surgery is an exciting area of minimally invasive surgery," Dr. Eduardo A. Perez said at the annual meeting of the American Pediatric Surgical Association. "There are known disadvantages, including limited lateral movement and dueling instruments, but industry is working hard to improve these platforms. This includes articulating instruments, flexible laparoscopes, multichannel ports, and robotic platforms."
Dr. Perez, of the division of pediatric surgery at Children’s Medical Center, Dallas, and his associates randomized 50 patients equally to either single-incision laparoscopic surgery (SILS) or conventional laparoscopy (LAP) for appendectomy and followed them for a median of 14 months. The technique for SILS involved a single supraumbilical curvilinear incision with three fascial incisions placed in a triangular fashion. To make SILS technically comparable to the LAP procedure, the researchers used a stapler device that required upsizing a 5-mm port to a 12-mm size. Cosmesis was not studied.
The children ranged in age from 3 to 15 years, and there were no significant age differences between the two treatment groups. Half of the patients were under age 8, 50% were male, and 67% were Hispanic.
The overall mean OR time was 46.8 minutes for the SILS procedure, compared with 34.8 minutes for the LAP procedure, a difference that was significant (P = .010). However, the OR time between groups became more similar as the number of cases increased. For example, after the first 25 patients were treated, the mean OR time for the SILS procedure was 49.3 minutes, compared with 33.5 minutes for the LAP procedure, a difference that remained significant (P = .049). After the last 25 patients were treated, the mean OR times were no longer significantly different between the two groups (a mean of 44.1 vs. 36 minutes, respectively).
There were no conversions and no differences in hospital length of stay between the two groups (a median of 40.3 hours for SILS vs. 36.7 hours for LAP).
The only complication was a wound seroma in the SILS group, and no hernias were observed. In addition, no differences were noted between the two groups in terms of hospital readmissions, diet tolerance, fever, or postoperative pain.
Operative times between SILS and LAP appendectomy "are similar once experience is gained," Dr. Perez concluded. "OR cost is similar when using standard instruments, but this will increase [in SILS] with the use of newer, more advanced instruments."
Dr. Perez said that he had no relevant financial disclosures to make.
The meeting was supported by a grant from Elsevier, which owns this news organization.
PALM DESERT, CALIF. – Single-incision laparoscopic surgical appendectomy is both feasible and safe across a wide range of pediatric patient ages, results from a single-center study showed.
"Single-incision laparoscopic surgery is an exciting area of minimally invasive surgery," Dr. Eduardo A. Perez said at the annual meeting of the American Pediatric Surgical Association. "There are known disadvantages, including limited lateral movement and dueling instruments, but industry is working hard to improve these platforms. This includes articulating instruments, flexible laparoscopes, multichannel ports, and robotic platforms."
Dr. Perez, of the division of pediatric surgery at Children’s Medical Center, Dallas, and his associates randomized 50 patients equally to either single-incision laparoscopic surgery (SILS) or conventional laparoscopy (LAP) for appendectomy and followed them for a median of 14 months. The technique for SILS involved a single supraumbilical curvilinear incision with three fascial incisions placed in a triangular fashion. To make SILS technically comparable to the LAP procedure, the researchers used a stapler device that required upsizing a 5-mm port to a 12-mm size. Cosmesis was not studied.
The children ranged in age from 3 to 15 years, and there were no significant age differences between the two treatment groups. Half of the patients were under age 8, 50% were male, and 67% were Hispanic.
The overall mean OR time was 46.8 minutes for the SILS procedure, compared with 34.8 minutes for the LAP procedure, a difference that was significant (P = .010). However, the OR time between groups became more similar as the number of cases increased. For example, after the first 25 patients were treated, the mean OR time for the SILS procedure was 49.3 minutes, compared with 33.5 minutes for the LAP procedure, a difference that remained significant (P = .049). After the last 25 patients were treated, the mean OR times were no longer significantly different between the two groups (a mean of 44.1 vs. 36 minutes, respectively).
There were no conversions and no differences in hospital length of stay between the two groups (a median of 40.3 hours for SILS vs. 36.7 hours for LAP).
The only complication was a wound seroma in the SILS group, and no hernias were observed. In addition, no differences were noted between the two groups in terms of hospital readmissions, diet tolerance, fever, or postoperative pain.
Operative times between SILS and LAP appendectomy "are similar once experience is gained," Dr. Perez concluded. "OR cost is similar when using standard instruments, but this will increase [in SILS] with the use of newer, more advanced instruments."
Dr. Perez said that he had no relevant financial disclosures to make.
The meeting was supported by a grant from Elsevier, which owns this news organization.
Dr. Eduardo A. Perez, American Pediatric Surgical Association, SILS, LAP, supraumbilical curvilinear incision,
Dr. Eduardo A. Perez, American Pediatric Surgical Association, SILS, LAP, supraumbilical curvilinear incision,
FROM THE ANNUAL MEETING OF THE AMERICAN PEDIATRIC SURGICAL ASSOCIATION
Major Finding: The overall mean OR time for SILS appendectomy was 46.8 minutes, compared with 34.8 minutes for conventional laparoscopy, a difference that was significant (P = .010). However, the OR time between groups became more similar as the number of cases increased.
Data Source: A study of 50 patients randomized to SILS or to conventional laparoscopy for appendectomy and followed for a median of 14 months.
Disclosures: Dr. Perez said that he had no relevant financial disclosures to make.