Single-Incision Laparoscopic Appendectomy: Feasibility Within an Acute Care Surgery Model

Konstantinos Spaniolas, MD, Christopher Richardson, DO, Ralph Doerr, MD. University of Rochester Medical Center, Rochester NY and Rochester General Hospital, Rochester, NY

Background: The feasibility of single-incision laparoscopic appendectomy (SILA) has been previously reported based on small series of patients from major academic centers. Data suggest that it is a safe and feasible procedure in the hands of surgeons with major academic and scientific background in minimally-invasive surgery. The objective of this study was to evaluate our experience with SILA within an acute care surgery model.

Methods: This is a retrospective study of our experience with SILA. All patients who underwent this operation were identified, demographics were collected and outcomes analyzed. Results are presented in median (range) unless otherwise specified.

Results: We identified 18 patients who underwent SILA; 50% were male of 40 (20 – 63) years of age with ASA score of 1 (0-3). The duration of the operation was 48 (31 – 62) minutes. Eight patients (44%) were operated at night-time (between 00:00 and 08:00 hours). All but one procedures were performed through a single-incision, with technical success rate of 94.4%; in the remaining one patient a second incision/port was necessary for adequate visualization of the appendix. No conversion to open appendectomy was required. The mean hospital length of stay was 1 (0 – 7) days. One patient presented to follow up with a wound infection; the overall complication rate of 5.6%.

Conclusions: SILA within an acute care surgery model is feasible and safe, and represents an alternative surgical technique for acute appendicitis, even for operations that are performed at night-time.