I don’t usually like to review papers that have only been published in abstract form or orally presented because complete data are not available for analysis. But I’m going to make an exception here because a recent paper presented at the American College of Surgeons annual meeting in October and featured on page 1 of Surgery News supports one of my many biases.
Researchers at the Chinese University of Hong Kong performed a trial involving 200 patients undergoing laparoscopic appendectomy randomized into two groups, conventional 3-port [3P] and laparoscopic single-site access [LESS]. The 3P approach uses 3 small incisions to insert the scope/camera and instruments while the LESS uses a single incision at the umbilicus with the scope/camera and instruments all inserted via the one incision.
Guess what? LESS was not only harder to perform [due to the inability to triangulate the instruments which are too close to each other] but it also caused significantly more postoperative pain.
Although LESS theoretically might result in a better cosmetic result because the only incision is in the umbilicus, the 3P procedure results in one scar in the umbilicus and two 5 mm scars in the lower abdomen. The two 5 mm scars are often invisible several months after surgery.
This study is one of the few large randomized trials on any type of single incision surgery and may be the first to show that LESS is inferior to the current standard. Because of their findings, lead author Dr. Anthony Y. B. Teoh said that his group “reverted to the three-port procedure” for patients presenting with appendicitis.
I previously blogged about a small study extolling the virtues of single-port robotic cholecystectomy, which purported to show [but did not] that it was better than the standard laparoscopic method.
Will there be more disillusionment with single-port surgery as larger and better designed studies emerge?