Lee Sung Min, Park Dong Jin, Yoon Jong Hee, Tae Soon Young, Yang Song Soo, Im Yeong Cheol
1 Department of Surgery, Ulsan University Hospital , Ulsan, Korea.
2 Department of Surgery, University of Ulsan College of Medicine , Ulsan, Korea.
J Laparoendosc Adv Surg Tech A. 2017 Oct;27(10):1031-1037. doi: 10.1089/lap.2017.0016. Epub 2017 Apr 14.
Conventional laparoscopic appendectomy (CLA) has been considered the standard for the treatment of acute appendicitis. Recently, single incision laparoscopic appendectomy (SILA) has become an alternative option. There are few reports on the results of SILA performed by residents during the training period. The present study, we report our residents' experience.
We reviewed clinical characteristics and outcomes of 1005 patients who underwent appendectomy between October 2013 and April 2016. Every operation was performed by only residents. Clinical characteristics and operative outcomes between SILA and CLA group were reviewed after propensity score matching.
SILA was used more frequently in younger patients (23.3 versus 36.4 years, P = .000), women (66.4% versus 45.9%, P = .000), and patients with lower body mass index (20.2 versus 22.9 kg/m, P = .043). After propensity score matching, the rate of complicated appendicitis was lower (12.9% versus 15.5%, P = .573), and the mean operative time was slightly shorter in the SILA group than in the CLA group (56.68 versus 59.09 minutes, P = .068), although these differences were not statistically significant. There were no significant differences between the two groups in hospitalization period (2.7 versus 2.9 days, P = .380), the use of analgesics (2.0 versus 2.1 times, P = .128), and wound complication rate (10.3% versus 14.6%, P = .333).
It is a safe and relatively easy procedure with an acceptable postoperative cosmetic outcome that can be incorporated into the routine surgical training.
传统腹腔镜阑尾切除术（CLA）一直被视为治疗急性阑尾炎的标准方法。近年来，单孔腹腔镜阑尾切除术（SILA）已成为一种替代选择。关于住院医师在培训期间实施SILA的结果报道较少。在本研究中，我们报告了我们住院医师的经验。
我们回顾了2013年10月至2016年4月期间接受阑尾切除术的1005例患者的临床特征和结局。所有手术均仅由住院医师完成。在倾向得分匹配后，对SILA组和CLA组之间的临床特征和手术结局进行了回顾。
SILA在年轻患者（23.3岁对36.4岁，P = 0.000）、女性（66.4%对45.9%，P = 0.000）以及体重指数较低的患者（20.2对22.9kg/m，P = 0.043）中使用更为频繁。倾向得分匹配后，SILA组复杂阑尾炎的发生率较低（12.9%对15.5%，P = 0.573），且平均手术时间略短于CLA组（56.68分钟对59.09分钟，P = 0.068），尽管这些差异无统计学意义。两组在住院时间（2.7天对2.9天，P = 0.380）、使用镇痛药次数（2.0次对2.1次，P = 0.128）以及伤口并发症发生率（10.3%对14.6%，P = 0.333）方面无显著差异。
这是一种安全且相对简单的手术，术后美容效果可接受，可纳入常规外科培训。
