Department of Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, #665, Bupyung-6-dong, Bupyunggu, 403-720, Incheon, Korea.
Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Korea.
Surg Endosc. 2021 Jun;35(6):2997-3002. doi: 10.1007/s00464-020-07744-9. Epub 2020 Jun 16.
Single-incision laparoscopic appendectomy (SIL-A) has recently become an option for treating appendicitis. The aim of this study was to evaluate the safety, feasibility, and surgical outcomes of SIL-A by residents and surgeons during the learning period.
A total of 1948 consecutive patients who underwent SIL-A from May 2008 to November 2014 were studied retrospectively. Surgeries were performed by residents and eight surgeons. Prior to the first case, surgeons and residents had been trained in a training protocol during the learning period. Three initial cases of SIL-A were performed under the supervision of experienced surgeons. Patients were divided into two groups: group 1 (learning period, n = 483), the first 40 cases by each surgeon and resident; and group 2 (experienced period, n = 1465), cases after the 40th procedure performed by each surgeon. Surgical results were compared between the two groups by performing propensity score matching analysis.
After propensity score matching, there was no significant difference in patient demographics and characteristics of appendicitis between the two groups. The operating time was longer in group 1 than in group 2 (45.3 ± 18.0 vs. 33.9 ± 16.1 min, p < 0.001). The morbidity rate (7.0% vs. 6.5%, p = 0.795) was similar between the two groups. Readmission rate (2.1% vs. 1.3%, p = 0.414) and reoperation rate (0.8% vs. 0.8%, p = 0.348) were also similar between the two groups. However, the rate of incisional hernia occurrence (0.6% vs. 0%, p = 0.066) tended to be larger in group 1 than in group 2 without showing a significant difference.
SIL-A is a technically feasible and safe procedure when it is performed by residents and surgeons during learning period under an appropriate training protocol. However, residents and surgeons in the learning period should perform it carefully to prevent incisional hernias.
单孔腹腔镜阑尾切除术（SIL-A）最近已成为治疗阑尾炎的一种选择。本研究旨在评估住院医师和外科医师在学习期间实施 SIL-A 的安全性、可行性和手术结果。
回顾性分析 2008 年 5 月至 2014 年 11 月期间行 SIL-A 的 1948 例连续患者。手术由住院医师和 8 位外科医师完成。在首例手术前，外科医师和住院医师已在学习期间按照培训方案进行了培训。前 3 例 SIL-A 手术在有经验的外科医师的监督下进行。患者分为两组：第 1 组（学习期，n=483），每位外科医师和住院医师的前 40 例；第 2 组（经验期，n=1465），每位外科医师的第 40 例以后的病例。通过倾向评分匹配分析比较两组患者的手术结果。
经倾向评分匹配后，两组患者的人口统计学特征和阑尾炎特征无显著差异。第 1 组的手术时间长于第 2 组（45.3±18.0 分钟比 33.9±16.1 分钟，p<0.001）。两组的发病率（7.0%比 6.5%，p=0.795）相似。两组的再入院率（2.1%比 1.3%，p=0.414）和再次手术率（0.8%比 0.8%，p=0.348）也相似。然而，第 1 组切口疝发生率（0.6%比 0%，p=0.066）高于第 2 组，但无统计学差异。
在适当的培训方案下，住院医师和外科医师在学习期间实施 SIL-A 技术上是可行且安全的。然而，学习期间的住院医师和外科医师应谨慎操作，以防止切口疝的发生。
