title: Impact of experience on quality outcomes in single-incision laparoscopy for simple and complex appendicitis in children.
abstract: BACKGROUND
  Single-incision laparoscopic appendectomy (SILA) is an effective treatment for appendicitis in children. We report our experience with SILA, focusing on how surgeon experience may impact quality outcomes.
  
  
  METHODS
  A retrospective review of patients who underwent SILA from August 2009 to November 2013 was performed. Patients were grouped by early experience, late experience without surgical trainees, and late experience with trainees and further stratified into simple and complex appendicitis.
  
  
  RESULTS
  SILA was performed on 703 patients with a mean age of 11.8±3.9years. Four hundred eleven (58.5%) patients were diagnosed with simple and 292 (41.5%) with complex appendicitis. There was a significant decrease in operative time between early and late groups for both simple and complex appendicitis. Following the introduction of surgical trainees, there was a significant increase in operative time compared to the late group for simple appendicitis. There were no significant differences in complication rates between any of the groups.
  
  
  CONCLUSIONS
  The adoption of SILA requires a significant learning curve even for the experienced laparoscopist with the potential for decreased operative times with experience. While there may be an increase in operative time with the introduction of trainees, this does not impact quality outcomes.
authors.affiliation: Division of Pediatric Surgery, All Children's Hospital Johns Hopkins Medicine, Saint Petersburg, FL, USA. Electronic address: sfarach1@jhmi.edu.
authors.forename: Sandra M
authors.initials: SM
authors.lastname: Farach
authors.affiliation: Division of Pediatric Surgery, All Children's Hospital Johns Hopkins Medicine, Saint Petersburg, FL, USA. Electronic address: Paul.Danielson@jhmi.edu.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Danielson
authors.affiliation: Division of Pediatric Surgery, All Children's Hospital Johns Hopkins Medicine, Saint Petersburg, FL, USA. Electronic address: Nicole.Chandler@jhmi.edu.
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Chandler
mesh_terms: D000293:Adolescent; D001062:Appendectomy / Q000379:methods*; D001064:Appendicitis / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D010535:Laparoscopy / Q000379:methods*; D059032:Learning Curve; D007902:Length of Stay; D008297:Male; D061646:Operative Time; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: Laparoscopic surgery; Pediatric surgery; Single incision; Single site