Sarah Eapen, MD1, Terry Carman, MD2, Charudutt Paranjape, MD, FACS2. 1Northside Medical Center, 2Akron General Medical Center
Objective: The learning curve of single-port surgery has been recognized as a barrier to its use in the treatment of acute appendicitis. We investigate the learning curve of our single-surgeon, high-volume experience with single-port laparoscopic appendectomy and compare it with multi-port laparoscopic appendectomy in this study.
Methods and Procedures: A retrospective review of operative time, appendicitis severity, and postoperative complications was conducted for 128 single-surgeon, single-port laparoscopic appendectomies (SPLA) and 941 multi-port, multi-surgeon laparoscopic appendectomies (MPLA) performed at Akron General Medical Center from April 2009 to December 2014. Statistical analysis was performed using Fisher’s test and t test.
Results: Patient demographics, body mass index, and advanced appendicitis rates were comparable between the two groups. From 2009 to 2011, there was no difference in operative time between SPLA (n = 58) and MPLA (n = 422). SPLA operative time was consistently and significantly shorter in 2012 (32.7 ± 18.2 minutes; p = 0.0016), 2013 (29.3 ± 6.7 minutes; p = 0.0037), and 2014 (38.5 ± 18.8 minutes; p = 0.0145) and improved from the beginning of the study in 2009 (55.1 ± 17.5 minutes) to the end in 2014 (38.5 ± 18.8 minutes; p = 0.0232). Overall, SPLA operative time was shorter (38.4 ± 19.0 minutes) compared to MPLA (46.1 ± 19.2 minutes; p = 0.0001). There were no differences in postoperative complications including ileus, urinary retention, deep space infection, incisional hernia, and thirty-day readmission.
Conclusions: Our study strongly supports the use of SPLA in the treatment of acute appendicitis and suggests the associated learning curve can be safely overcome. After approximately 58 cases, SPLA technique can be mastered to achieve operative time superior to MPLA without compromising safety.