Evolving Paradigms in Minimal Access Surgery: A Comprehensive Review of Single-Incision Laparoscopic Appendicectomy

TL;DR

This review compares single-incision laparoscopic appendicectomy with conventional laparoscopic appendicectomy, finding similar safety but better recovery and cosmetic results with the single-incision method.

Contribution

The paper provides a comprehensive analysis of 24 studies to evaluate the efficacy and cost-effectiveness of single-incision laparoscopic appendicectomy.

Findings

SILA showed faster recovery and lower pain scores compared to CLA.

Glove-port SILA reduced costs by 45-60% compared to CLA.

Operative time for SILA equalized with CLA after 20-25 cases.

Abstract

Single-incision laparoscopic appendicectomy (SILA) has emerged as an evolution of minimally invasive surgery, aiming to minimize access trauma while maintaining the advantages of conventional laparoscopic appendicectomy (CLA). This review analyzes the cumulative evidence from 24 PubMed-indexed studies comparing SILA and CLA, with a focus on safety, operative outcomes, cosmesis, and the cost-saving impact of glove-port innovations.

A structured literature review was performed using PubMed, including 24 studies (12 randomized controlled trials, seven meta-analyses, three retrospective cohorts, and two feasibility studies). Data were extracted for operative duration, pain scores, complications, hospital stay, cosmetic satisfaction, and economic parameters. Studies involving pediatric, adult, and complicated appendicitis cases were included.

Across 10,968 patients (SILA = 5,246; CLA = 5,722), no significant difference was observed in major complications, hospital stay, or infection rates. SILA demonstrated shorter recovery (3.8 vs. 4.5 days), lower pain scores (Visual Analogue Scale (VAS) 3.2 vs. 3.5), and superior cosmetic satisfaction (9.1 vs. 7.8). The mean operative time was initially longer for SILA (49.8 vs. 42.5 minutes) but equalized after 20-25 cases. Glove-port SILA reduced costs by 45-60% compared to CLA. The overall wound infection rate was 2.5% for SILA versus 2.7% for CLA, and umbilical hernia occurrence was 1.3% versus 0.9%, respectively.

SILA offers comparable safety and faster recovery than CLA, with enhanced cosmetic outcomes and substantial cost benefits using glove-port techniques. Once the learning curve is surpassed, SILA is an effective, safe, and accessible alternative for uncomplicated appendicitis, especially in cost-conscious healthcare settings.

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