title: Needlescopic versus laparoscopic appendectomy: a systematic review.
abstract: BACKGROUND
  Needlescopic appendectomies (NA) have been performed since the 1990s. We sought to systematically analyze trials comparing NA with laparoscopic appendectomies (LA) in the management of appendicitis.
  
  
  METHODS
  We performed a systematic review of the literature. We compared and analyzed clinical trials on NA and LA to generate summative data expressed as standardized mean differences (SMD).
  
  
  RESULTS
  Of 5 retrieved trials from the electronic database 2 trials involving 412 patients met our inclusion criteria. In the fixed-effects models, NA took longer than LA, and this time difference was statistically significant: SMD 0.20 min, 95% confidence interval 0.01-0.40, p = 0.030, z(1) = 2.09. In both fixed-and random-effects models, the difference in total hospital stay and in perioperative complications between the NA and LA groups were nonsignificant. Furthermore, in both fixed-and random-effects models, NA was associated with a higher conversion rate to open appendectomy than LA. There was no heterogeneity between the trials (Q = 0.34, p = 0.55).
  
  
  CONCLUSIONS
  Needlescopic appendectomy can be a safe and effective procedure for the management of appendicitis. It is comparable to LA in terms of hospital stay and perioperative complications. However, NA is associated with a longer duration of surgery and a higher conversion rate, indicating technical challenges of the procedure. Before recommending routine use of the needlescopic technique for appendectomy, a major multicentre randomized controlled trial is necessary.
authors.affiliation: Department of Colorectal Surgery, Worthing Hospital, Worthing, West Sussex, UK. surgeon1wrh@hotmail.com
authors.forename: Muhammad Shafique
authors.initials: MS
authors.lastname: Sajid
authors.forename: Munir Ahmad
authors.initials: MA
authors.lastname: Khan
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Cheek
authors.forename: Mirza Khurrum
authors.initials: MK
authors.lastname: Baig
mesh_terms: D001062:Appendectomy / Q000295:instrumentation* / Q000379:methods*; D001064:Appendicitis / Q000601:surgery; D002986:Clinical Trials as Topic; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D011183:Postoperative Complications