General Surgery Podium Presentation: Adopting Single-Incision Laparoscopic Appendectomy in Children: Is It Safe During the Learning Curve?
Has Audio
Introduction/Purpose: Laparoscopic appendectomy is the gold standard for treatment of acute appendicitis. However, there is minimal data on the outcomes during the adoption of this technique in the era of wide laparoscopic experience in training and practice. This study evaluates the learning curve of contemporarily trained surgeons adopting SILS appendectomy, and more specifically, the safety of the operation during the early portion of this learning curve.
Methods or Case Description: A retrospective review of 974 consecutive pediatric patients who underwent an appendectomy at the Children’s Hospital of Illinois from 2005 to 2018 was performed. A subgroup analysis was then performed for the technique of single incision laparoscopy; a total of 438 were included. The adoption of this technique by new partners in the group was evaluated. Outcomes measured included length of operation, length of anesthesia time, and complication rate (surgical site infection).
Outcomes: A trend to faster operative times was observed for all surgeons as case numbers increased. Based on a 95% confidence band using a Loess smoothing method and this experienced time as the standard, we expect adopting surgeons to reach this experienced level after 51 cases. During this early SILS appendectomy learning curve, there was no significant difference in complication rate when compared to conventional multi-port laparoscopy.
Conclusion: As expected, the more single incision cases performed, the shorter the operative times. More importantly, we did not find an increase in complications during this learning stage of single incision appendectomies in either perforated or non-perforated appendicitis. We conclude that the adoption of SILS appendectomies is safe even in the learning curve of the technique given contemporary minimally invasive training/practice.
Learning Objectives:
recognize the need for further research and evaluation as to the safety of SILS in pediatric surgical candidates.
define the advantages to performing SILS rather than traditional laparoscopy.
asses the importance of the learning curve in newly trained surgeons.
illustrate the concept that SILS is a variation in approach and not a variation in technique.
evaluate the need for more general surgery residency programs to incorporate single-incision training into their program
