• appendicitis
• laparoscopic surgery
• minimally invasive surgery
• pediatric surgery
• tulaa

• Acute appendicitis
• Appendectomy
• Appendicectomy
• ERAT
• Historical overview
• History
• History of medicine
• Laparoscopic
• Laparoscopy

• Appendicitis/history
• Appendicitis/surgery
• Appendicitis/therapy
• Humans
• History, Ancient
• History, 19th Century
• History, 20th Century
• Appendectomy/history
• Appendectomy/methods
• History, Medieval
• History, 18th Century
• History, 21st Century
• History, 16th Century
• History, 15th Century
• History, 17th Century
• Acute Disease
• Laparoscopy/history

• Adult
• Child
• Humans
• Pain Management/methods
• Pain, Postoperative/diagnosis
• Pain, Postoperative/etiology
• Pain, Postoperative/prevention & control
• Analgesics/therapeutic use
• Acetaminophen
• Anti-Inflammatory Agents, Non-Steroidal/therapeutic use
• Anesthetics, Local/therapeutic use

• Appendectomy
• Appendicitis
• Meta-analysis
• Single-incision laparoscopy

• Humans
• Acute Disease
• Appendectomy/methods
• Appendicitis/surgery
• Laparoscopy/methods
• Operative Time
• Randomized Controlled Trials as Topic
• Treatment Outcome

• appendectomy
• children
• conventional
• laparoscopy
• single-incision

• laparoscopic appendectomy
• minimally invasive
• single incision

• Appendectomy
• Conventional laparoscopic
• Meta-analysis
• Single-incision laparoscopic

This study was performed to compare the efficacies of newly developed needle grasper-assisted (Endo Relief) single-incision laparoscopic appendectomy (NASILA) and single-incision laparoscopic appendectomy (SILA).

This study enrolled 110 patients with acute appendicitis without periappendiceal abscess, diagnosed using computed tomography, who were randomized to the SILA (n = 54) and NASILA groups (n = 56) between December 2017 and August 2018 (6 patients withdrawn). The NASILA technique entailed a small umbilical incision for the glove port (equivalent to that for a 12-mm trocar), and a 2.5-mm suprapubic incision for the needle grasper.

The SILA and NASILA groups included 49 (male, 61.2%) and 55 (male, 54.5%) patients, respectively. Age, body mass index, abdominal surgical history, symptom duration, and use of patient-controlled analgesia did not differ significantly between the 2 groups. The main wound size was significantly smaller in the NASILA group than in the SILA group (1.8 ± 0.4 cm vs. 2.2 ± 0.4 cm, P < 0.001). The operative time and estimated blood loss did not differ significantly between both groups. The immediate postoperative pain score, i.e., the primary endpoint, was significantly lower in the NASILA group than in the SILA group (2.33 ± 0.98 vs. 2.82 ± 1.29, P = 0.031). The complaints for scar status 1 month postoperatively did not differ significantly between the groups.

NASILA could attenuate postoperative pain by minimizing the size of the surgical wound; further, NASILA may not be inferior to SILA in terms of cosmetic results.

• Appendectomy
• Laparoscopy
• Surgical instruments
• Surgical wound

• Gastric or intragastric resections
• Gastroenterology
• Single port surgery
• Surgical complication
• Surgical technique

• Humans
• Gastroenterology
• Laparoscopy
• Minimally Invasive Surgical Procedures

• Advances
• Appendicitis
• COVID-19
• Controversy
• Diagnosis
• Management

Although single-incision laparoscopic appendectomy (SILA) was introduced decades ago, it is still considered a difficult technique to perform compared to conventional laparoscopic appendectomy (CLA). In addition, controversy about the benefits of SILA compared to CLA abound and no definite criteria for choosing SILA over CLA in patients with appendicitis currently exist. Therefore, we have planned a multi-center randomized controlled trial to compare SILA with CLA in terms of cosmetic satisfaction and pain reduction.

Patients diagnosed with appendicitis at the participating centers will be recruited and allocated into either a CLA or an SILA groups using a 1:1 randomization. Patients in the CLA group will receive a conventional 3-port laparoscopic appendectomy and patients in the SILA group will receive a laparoscopic appendectomy using a single-incision at the umbilicus. The primary trial endpoint is cosmetic satisfaction assessed using the Patients and Observer Scar Assessment Scale (POSAS) administered 6 weeks post-surgery. Secondary trial endpoints include cosmetic satisfaction assessed via the Body Image Questionnaire, pain levels assessed via the Visual Analog Scale and International Pain Outcomes questionnaire, and the presence of postoperative complications. The target sample size of this superiority trial is 120 patients, as this will provide 80% power at the 2.5% level of significance to detect a 3-point difference in POSAS.

The results of this planned multi-center randomized controlled trial will provide substantive evidence to help surgeons choose when to use SILA over CLA in patients with appendicitis.

This trial was approved by the institutional review board at Daegu joint on February 27, 2020 (No: 19-12-001-001) and registered with the clinical research information service (CRIS) (KCT0005048). The results of the study will be published and presented at appropriate conferences.

• appendicitis
• conventional laparoscopic appendectomy
• single-incision laparoscopic appendectomy

• Appendicectomy
• Laparoscopic surgery
• Single port laparoscopic surgery

• Appendicectomy
• Laparoscopic surgery
• Single port

• Appendectomy
• ArtiSential®
• Articulating instrument
• Single incision

• Appendectomy
• Enhanced recovery after surgery
• Laparoscopy
• Pain management
• Pain, postoperative

• Appendectomy
• cholecystectomy
• laparoscopic surgery
• laparoscopy
• single incision
• splenectomy

• endoscopic surgery
• endoscopy
• fetal surgery
• minimally invasive surgery
• open surgery
• pediatric surgery
• single-incision surgery
• surgical devices
• surgical techniques

Single-port laparoscopic techniques can be optimized with confined incisions. This approach has an intraoperative advantage of excellent visualization of the correct intestinal segment for exteriorization, along with direct visual control of the extraction to avoid twisting. However, only a few studies have verified the efficacy of the technique. Thus, this study assessed the results of single-port laparoscopic stoma creation for fecal diversion, specifically focusing on feasibility, safety, and efficacy.

Patients who underwent single-incision enterostomy performed by a single surgeon were included. Data on demographics, indications for and chosen procedure, and operation results were retrospectively collected and analyzed.

Between April 2015 and January 2018, a total of 13 patients (8 males, 5 females) with a mean age of 57.7 years (range, 41–83 years) underwent single-port ileostomy creation. The most common reason for diversion was palliative ileostomy for colon obstruction or fistula from peritoneal malignancy (n = 12), followed by colonic fistula with necrotizing pancreatitis (n = 1). There were no cases of conversion to open or multiport laparoscopic surgery. The mean operative time was 54 minutes (range, 37–118 minutes), and the median length of hospital stay was 8 days (range, 2–211 days). A postoperative complication, aspiration pneumonia, was documented in 1 patient and treated conservatively. The mean duration of bowel movement was 0.7 days (range, 0–4 days). All stomas had good function, and there was no 30-day mortality.

Single-port laparoscopic ileostomy in patients with a palliative setting could be a safe and feasible option for fecal diversion.

• Palliative surgery
• Postoperative complications
• Safety
• Single-port laparoscopic ileostomy

Background and objectives: Single-port laparoscopic appendectomy (SLA) in most previous studies has used intracorporeal excision of the appendix and needed a longer operative time than multi-port laparoscopic appendectomy (MLA), although SLA does have the potential benefit of an almost invisible scar within the umbilicus. Some studies have reported that extracorporeal transumbilical single-incision laparoscopic-assisted appendectomy (TULAA) in children took a considerably reduced operative time compared to MLA. We adopted TULAA in adults, adding routine dissection of the peritoneal attachment of the appendix. The aim was to compare the operative outcomes between TULAA and MLA. Materials and Methods: Between March 2013 and January 2016, 770 patients with acute uncomplicated and complicated appendicitis from 15 to 75 years of age were enrolled retrospectively. The operation was performed as early (EA) and interval appendectomy (IA). Results: Operative time was shorter in the TULAA group than in the MLA group, except for IA. No open conversion occurred in the TULAA group, except one case of ileocecal resection for IA. No intra-abdominal fluid collection was found in the TULAA group. Extended resection (especially partial cecectomy) was performed less frequently in the TULAA group than in the MLA group for IA. Mean postoperative hospital stay was shorter in the TULAA group for uncomplicated appendicitis. When the data of the EA group and the IA group were compared, operative time was significantly shorter in the IA group for both MLA and TULAA. The open conversion rate and the complication rate tended to be lower in the IA group. Confined to IA, the TULAA group tended to have shorter mean initial, postoperative, and total hospital stays. Conclusions: TULAA can be a useful surgical alternative to MLA in adults and young adolescents, because it lacks open conversion and provides both a shorter operative time and a shorter postoperative hospital stay. TULAA is feasible for IA in that it showed a lower rate of extended resection and complications.

• appendectomy
• appendicitis
• interval appendectomy
• laparoscopic appendectomy
• transumbilical single-port laparoscopic-assisted appendectomy

• appendectomy
• laparoscopy
• needle grasper
• reduced port
• single incision

• Appendectomy
• Appendicitis
• Complications
• NOTES
• Surgical procedures