Masaki Wakasugi, Naoto Tsujimura, Yujiro Nakahara, Takashi Matsumoto, Hiroyoshi Takemoto, Ko Takachi, Kiyonori Nishioka, Satoshi Oshima. Kinki Central Hospital
Purpose: To confirm the safety and the feasibility of single-incision laparoscopic appendectomy (SILA) performed by the residents.
Methods:
Clinical setting
We analyzed, retrospectively, 86 consecutive patients who underwent SILA between August, 2010 and August, 2016 at Kinki Central Hospital. During the study period, 9 residents and 6 board-certified attending surgeons performed SILA.
Surgical technique
The skin incision was performed intraumbilically. EZ access and Lap-Protector were used to maintain the pneumoperitoneum. After the ileocecum was mobilized with conventional straight forceps and the laparoscopic coagulation shears, the appendix was delivered through the umbilical wound. The stump of the appendix was inverted with a purse- string suture, as in open appendectomy. Depending on the operating surgeon’s choice and the surgical field, Endo GIA Universal Stapling System was used to resect the appendix. The umbilical wound was closed in two layers in a routine fashion.
Data collection
The patient characteristics and the perioperative complications were collected from the medical records. Whether the patients had complicated appendicitis with gangrenous appendicitis or perforation of the appendix was evaluated, in addition to the baseline demographic data.
Results: The resident doctors operated on 55% (47/86) of patients undergoing SILA in our hospital. There were no significant differences between the groups with regard to the patient characteristics. The mean operative time in the resident and staff surgeon groups was 74 min (range 25-166 min) and 71 min (range 36-160 min), respectively (p = 0.5). The median blood loss in the resident and staff surgeon groups was 0 mL (range 0-50 mL) and 0 mL (range 0-63 mL), respectively (p = 0.3). The rate of conversion to a different operative procedure was 4% (2/47) of the patients in the resident group and 3% (1/39) of those in the staff surgeon group, respectively (p = 1). Two procedures (4%, 2/47) in the resident group were converted to multi-port laparoscopic appendectomy. One procedure (3%, 1/39) in the staff surgeon group was converted to multi-port laparoscopic appendectomy. The mean postoperative hospital stay was 5 days (range 2-8 days) for the resident group and 5 days (range 3–15 days) for the staff surgeon group (p = 0.7). Perioperative complications developed in 9% (4/47) of the patients in the resident group and 21% (8/39) of the patients in the staff surgeon group (p = 0.1).
Conclusions: Single-incision laparoscopic appendectomy performed by residents is safe and feasible with the guidance of a staff surgeon.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 77855
Program Number: P293
Presentation Session: Poster (Non CME)
Presentation Type: Poster
