Feasibility of Routine Single Incision Laparoscopic Appendectomy in UK District General Hospitals: A Prospective Study

Although many studies have demonstrated the feasibility of single-incision laparoscopic (SILS) appendectomy, this procedure has not become routine. In part this may be due to the perception that SILS appendectomy has additional resource requirements compared to conventional laparoscopic appendectomy in terms of personnel, time and equipment. The purpose of this prospective study was to assess the feasibility of a UK trainee performing routine SILS appendectomy with standard equipment. Prospective analysis of all consecutive adults who underwent laparoscopy for presumed appendicitis was performed. Cases were performed either by a senior trainee who exclusively performed SILS appendectomy on all patients using standard laparoscopic equipment, or other senior or junior trainees performing a conventional three-port laparoscopic appendectomy. Seventeen patients had SILS operations: 15 appendectomies, one resection of inflamed Meckel’s diverticulum and one appendectomy with oophorectomy. SILS was successfully completed in 14 cases whilst in three cases one extra port was added. Comparison of the 15 SILS operations that involved an appendectomy only with consecutive cohorts of three-port appendectomies performed by junior and senior trainees showed no significant difference in complications or length of hospital stay. There was no significant difference in operating time between SILS and junior trainee (P = 0.54), however the senior trainees had a significantly reduced operating time as compared to both SILS and junior trainee groups (P = 0.01). SILS appendectomy can be successfully performed by trainees on all-comers with comparable resource utilisation and clinical outcomes to those achieved by junior trainees performing a conventional three-port laparoscopic approach.