title: A prospective, randomized controlled trial of single-incision laparoscopic vs conventional 3-port laparoscopic appendectomy for treatment of acute appendicitis.
abstract: BACKGROUND
  Proponents of single-incision laparoscopic surgery (SILS) claim patients have less pain, faster recovery, and better long-term cosmetic results than patients who undergo multiport laparoscopy. However, randomized comparisons are lacking. This study presents the results of a prospective randomized trial of SILS or 3-port laparoscopic appendectomy.
  
  
  METHODS
  Adults with uncomplicated acute appendicitis were randomized 1:1 to either SILS or 3-port laparoscopic appendectomy. The primary end point was early postoperative pain (measured by opiate usage and pain score in the first 12 hours). Secondary end points were operative time, complication rate (including conversions), and recovery time (days of oral opiate usage and return to work). After 6 months, body image and cosmetic appearance were assessed using a validated survey.
  
  
  RESULTS
  The trial was planned for 150 patients, but was halted after 75 patients when planned interim analysis showed that SILS patients had more postoperative pain (pain score: 4.4 ± 1.6 vs 3.5 ± 1.5; p = 0.01) and higher inpatient opiate usage (hydromorphone use: 3.9 ± 1.9 mg vs 2.8 ± 1.7 mg; p = 0.01) than 3-port laparoscopy. Operative time for SILS averaged 40% longer (54 ± 17 minutes vs 38 ± 11 minutes; p < 0.01). Only 1 SILS case was converted to 3-port. There were no significant differences in length of stay, complications, oral pain medication usage after discharge, or return to work. After 6 months, body image and cosmetic appearance were excellent for both groups and indistinguishable by most measures. However, 3-port patients reported better physical attractiveness (4.0 ± 0.4 vs 3.8 ± 0.4; p = 0.04) and SILS patients reported better scars (score 18.4 ± 2.7 vs 16.4 ± 3.0; p < 0.01). Results are reported as mean ± SD.
  
  
  CONCLUSIONS
  Single-incision laparoscopic surgery appendectomy resulted in more pain and longer operative times without improving short-term recovery or complications. Long-term body image and cosmetic appearance were excellent in both groups.
authors.affiliation: Department of Surgery, University of California, San Francisco, San Francisco, CA. Electronic address: jonathan.carter@ucsfmedctr.org.
authors.forename: Jonathan T
authors.initials: JT
authors.lastname: Carter
authors.affiliation: Department of Surgery, University of California, San Francisco, San Francisco, CA.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Kaplan
authors.affiliation: Department of Molecular and Cell Biology, University of California, Berkeley, Berkeley, CA.
authors.forename: Jason N
authors.initials: JN
authors.lastname: Nguyen
authors.affiliation: Department of Surgery, University of California, San Francisco, San Francisco, CA.
authors.forename: Matthew Y C
authors.initials: MY
authors.lastname: Lin
authors.affiliation: Department of Surgery, University of California, San Francisco, San Francisco, CA.
authors.forename: Stanley J
authors.initials: SJ
authors.lastname: Rogers
authors.affiliation: Department of Surgery, University of California, San Francisco, San Francisco, CA.
authors.forename: Hobart W
authors.initials: HW
authors.lastname: Harris
mesh_terms: D000208:Acute Disease; D000328:Adult; D001062:Appendectomy / Q000379:methods*; D001064:Appendicitis / Q000601:surgery*; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D020706:Laparoscopes; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome