Modified single-port laparoscopic appendectomy using needle-type grasping forceps vs conventional three-port laparoscopic appendectomy for acute uncomplicated appendicitis.

Background: Single-port laparoscopic appendectomy is an advanced minimally invasive surgery that involves the use of upgraded instruments and equipment. We previously modified single-port laparoscopic appendectomy with needle-type grasping forceps (mSLAN) for patients with simple appendicitis, but the feasibility and safety of our modified procedure need further evaluation in a high-quality clinical study.

Aim: To compare the short-term clinical outcomes of mSLAN with those of conventional three-port laparoscopic appendectomy (CLA) for patients with acute uncomplicated appendicitis.

Methods: This single-center, single-blind, prospective, randomized controlled trial included patients who underwent emergency laparoscopic appendectomy for acute uncomplicated appendicitis at our center between April 2024 and August 2024. Patients were randomly divided into the mSLAN group or the CLA group via computer-generated randomization. The primary endpoint was the 24-hour postoperative visual analog scale (VAS) score, and the secondary endpoints included the operative time, 24-hour postoperative inflammatory response biomarkers (including white blood cells, the neutrophil ratio, interleukin-6, and C-reactive protein), time to first postoperative exhaust, time to first out-of-bed activity, postoperative length of hospital stay, cost of hospitalization, and incidence of postoperative complications.

Results: A total of 72 patients were enrolled and randomly divided into 2 groups: The mSLAN group (n = 36) and the CLA group (n = 36). The 24-hour VAS scores, 24-hour postoperative inflammatory response marker levels, first postoperative exhaust times, first out-of-bed activity times, postoperative lengths of hospital stay, operative times, or hospitalization costs did not significantly differ between the two groups. No postoperative complications, including incision infection or hernia, abdominal abscess or intestinal obstruction, were observed during the 1-month postoperative follow-up in either group.

Conclusion: Compared with the CLA protocol, the mSLAN protocol for acute uncomplicated appendicitis yielded comparable short-term clinical outcomes, with a similar operative time and better cosmetic outcomes, indicating its potential for clinical application and superiority for patients with high cosmetic requirements. Further research is needed to evaluate the long-term outcomes.