Burjonrappa Sathyaprasad C, Nerkar Hrishikesh
Maimonides Infants and Children's Hospital, Brooklyn, NY 11219, USA.
JSLS. 2012 Oct-Dec;16(4):619-22. doi: 10.4293/108680812X13462882737339.
Laparoscopic appendectomy is accepted as the gold standard technique for the treatment of acute appendicitis. Recently single-incision laparoscopic surgery (SILS) was tried in the pediatric population and was shown to be both feasible and safe. We describe our early experience in teaching the SILS procedure for appendicitis in a large community hospital center surgical residency program.
SILS appendectomy was performed in 40 consecutive patients with acute appendicitis who were admitted by a single surgeon from May 2011 to August 2011. All patients over the age of 4 y presenting with noncomplicated and complicated appendicitis (perforated) were offered SILS appendectomy. Execution of the technical aspects of 20 SILS operations done by 3 PGY III residents was evaluated.
The average age of the patient was 11.1 y (range, 7 to 15). SILS was performed successfully in 19 out of 20 patients. Nineteen patients underwent emergent or urgent appendectomy, while 1 patient underwent an interval procedure. Nine patients were found to have perforated appendicitis, while the other 11 had noncomplicated acute appendicitis. One patient was converted to conventional 3-port laparoscopy due to difficulties during the procedure. The mean operative time was 73 min (range, 47 to 112). A significant learning curve to successfully execute the critical steps of the SILS procedure was noted in all residents evaluated.
SILS technology appears promising for the treatment of acute appendicitis. However, its successful incorporation into surgical training programs will depend on the development of innovative simulation strategies.
腹腔镜阑尾切除术被公认为治疗急性阑尾炎的金标准技术。最近，单孔腹腔镜手术（SILS）在儿科患者中进行了尝试，并被证明是可行且安全的。我们描述了在一家大型社区医院中心外科住院医师培训项目中教授SILS治疗阑尾炎手术的早期经验。
2011年5月至2011年8月，由一名外科医生连续为40例急性阑尾炎患者实施SILS阑尾切除术。所有4岁以上患有非复杂性和复杂性阑尾炎（穿孔性）的患者均接受SILS阑尾切除术。对3名三年级住院医师所做的20例SILS手术的技术操作进行了评估。
患者的平均年龄为11.1岁（范围7至15岁）。20例患者中有19例成功实施了SILS手术。19例患者接受了急诊或紧急阑尾切除术，1例患者接受了择期手术。9例患者被发现患有穿孔性阑尾炎，其他11例患有非复杂性急性阑尾炎。1例患者因手术过程中出现困难而转为传统三孔腹腔镜手术。平均手术时间为73分钟（范围47至112分钟）。在所有接受评估的住院医师中，均注意到成功执行SILS手术关键步骤存在明显的学习曲线。
SILS技术在治疗急性阑尾炎方面似乎很有前景。然而，其成功纳入外科培训项目将取决于创新模拟策略的发展。
