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Introduction: Two decades ago, single-incision surgery was established as a new concept in minimally invasive surgery. Single incision cholecystectomy is the most frequently performed procedure in clinical routine. Most of the results have been based on randomised trials. Large prospective multicentre observational datasets from clinical routine do not exist. This analysis of clinical health service research is based on the SILAP study (single-incision multiport/single port laparoscopic abdominal surgery study)., Patients and Methods: The data of the register were collected in 47 hospitals in the period of 2012 to 2014. Overall morbidity and mortality were the primary outcome. Multiple linear and logistic regression analyses were performed. Statistical significance was set at p < 0.05., Results: Data from 975 patients in clinical routine with single incision cholecystectomy were collected. Intraoperative complications were recorded in 3.2% of cases. Bile duct injuries were registered in 0.1% of cases. Postoperative complications were detected in 3.7% of cases. The mortality rate was 0.2%.The median operating time dropped from 60.0 to 51.5 min (p < 0.001) during the study. The use of an extra trocar was necessary in 10.3% of cases. Conversion to open surgery was performed in 0.7% of cases. Body mass index (p = 0.024), male gender (p = 0.012) and operating time (p < 0.001) had a significant effect on intraoperative complications in multivariate analysis. Classification of ASA III (p = 0.001) and modification or conversion of single incision technique (p = 0.001) were significantly associated with postoperative complications., Conclusion: The register analysis of the prospective multicentre data shows that single incision cholecystectomy is feasible in clinical routine even outside the selective criteria of randomised studies. The only limitation is a BMI > 30 kg/m 2 which has a significant influence on the intraoperative rate of complications in mild adverse events., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Objective: The treatment of acute appendicitis has seen changes in diagnosis and therapy in Germany. The objective of this analysis was to assess changes in therapy and outcome after open appendectomy (OA) and laparoscopic appendectomy (LA) over the last 21 years., Background: The analysis was based on 3 prospective multicenter quality assurance studies conducted by the Institute for Quality Control in Operative Medicine of the University of Magdeburg., Methods: All inpatients with a diagnosis of appendicitis in these studies (1988/1989, 1996/1997, 2008/2009) were included. Multiple linear and logistic regression analyses were performed. Statistical significance was set at P < 0.05., Results: Data from 17,732 treatments of patients diagnosed with appendicitis were collected. The average age of patients increased between the 3 studies from 25.7 to 34.6 years (P < 0.001). The preoperative selection of LA or OA was based on American Society of Anesthesiologists' classification (P < 0.001). Between 1996/1997 and 2008/2009, the share of LA climbed from 33.1% to 85.8% (P < 0.001). In the study from 2008 to 2009, LA showed a significant advantage over the conventional technique in wound healing disturbances (P < 0.001) and the clinical duration of stay (P < 0.001). At no stage of appendix inflammation did LA significantly increase intra-abdominal abscesses. The use of a stapler is currently the most common method of appendiceal stump closure (83.6%)., Conclusions: Changes in patient data reflected demographic changes. Preoperative selection leads to 2 clearly defined groups. LA is the most dominant method of current operative therapy. The negative selection in OA group has influenced the worse outcome of that group.

Introduction: With about 135,000 operations every year appendectomy is one of the most frequent surgical operations in Germany. Acute appendicitis has shown changes in diagnosis and therapy with time. The status of the laparoscopic appendectomy has had to be redefined recently. The aim of this study was to make an analysis of the current surgical therapy for appendicitis and the individual procedures., Patients and Methods: Three prospective multi-centre quality assurance studies (1988 / 89, 1996 / 97; 2008 / 09) of the "An-Institut" acquired 17,732 treatments from all supply levels of Germany., Results: The average age of patients increased within of the three studies from 25.7 to 34.6 years. Within the studies in 1996 / 97 and in 2008 / 09 the share of laparoscopic appendectomy advanced from 33.1 to 85.8 percent. In the study from 2008 / 09 the laparoscopic appendectomy showed a significant advantage over the conventional technique in terms of wound-healing disturbances (p < 0.001) and a clinical duration of stay (p < 0.001). At no stage of the appendix inflammation did the laparoscopic appendectomy lead to a significant increase of intraabdominal abscesses. Compared with the conventional technique the operating time was shorter (46.6 min vs. 53.5 min). Currently the use of a stapler is the mostly frequently applied method of appendiceal stump closure (83.6 percent)., Conclusion: The laparoscopic appendectomy is the most common method of current operative therapy. In comparison to former publications, there is no proof of any disadvantages of laparoscopic appendectomy., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: An inadequate closure of the appendix stump leads to intra-abdominal surgical site infection. The effectiveness of various appendiceal stump closure methods, for instance, staplers or endoloops, was evaluated. Many analyses show that the use of a stapler for transection and closure of the appendiceal stump lowers the risk of this infection but a statistically significant risk of postoperative intra-abdominal abscess or wound infection was not considered in any randomized study. The aim of this study was to evaluate the complications after using endoloops in a high-volume center., Methods: The data of 1,790 patients who underwent laparoscopic appendectomy between January 1998 and December 2006 and a single center was prospectively acquired. The standard procedure used was an appendiceal stump closure using endoloops and a selective use of staplers. The outcome criteria for inclusion in the study were intra-abdominal abscess formations, other specific intraoperative and postoperative complications, and the different costs of the operation., Results: Laparoscopic appendectomy was performed in 1,790 (80.8%) patients and open appendectomy in 425 (19.2%) patients. Conversion to open surgery occurred in 74 (4.13%) patients. Laparoscopic appendectomy with stump closure using endoloops was performed in 1,670 (97.3%) patients and stump closure using a stapler in 46 (2.7%) patients. Among 851 patients with acute appendicitis, 284 patients with perforated appendicitis, and 535 patients with other or no pathology, the rate of intra-abdominal abscess after using an endoloop or a stapler was not significantly different (1.5 vs. 0%, p = 0.587; 3.5 vs. 4.2%, p = 0.870; 0.7% vs. 0, p = 0.881, respectively). There were no significant differences between the endoloop group and the stapler group with respect to the other specific intraoperative and postoperative complications., Conclusion: This study shows the safety of the endoloop for clinical daily routine. A selective procedure for stump closure has been established. Appendiceal stump closure using an endoloop is an easy, safe, and cost-effective procedure.

A laparoscopic resection is a new treatment for pancreatic tumors. Articles by surgeons who are writing about their first experience in carrying out this treatment have appeared in the literature, reporting that laparoscopic surgery can be used for the treatment of pancreatitis, benign lesions, and solid tumors. This is a study of three patients with pancreatic tumors who were treated by means of a laparoscopic distal pancreatic resection with preservation of the spleen and splenic vessels. In three cases a laparoscopic distal resection was performed for the tumor. The histologic examinations showed one insulinoma and two mucinous cystadenomas. No patient suffered from intra- or postoperative complications. A laparoscopic resection of the distal pancreas is a new alternative for the treatment of pancreatic tumors. This method takes advantage of the benefits of minimally invasive surgery.

Background: Using data and analysis compiled in the nationwide German Colon/Rectal Cancer qualitative multicenter study, the aim of this study was to determine the value of laparoscopic surgery for colon cancer in clinical routine., Methods: From 1 January 2000 to 31 December 2003, patients with colon cancer resections were evaluated for short-term postoperative and long-term oncologic results associated with operative approach (laparoscopic vs conversion vs open)., Results: Of 21,721 patients with colon cancer, 949 (4.4%) underwent laparoscopic resection. These patients were younger (P<0.001) with lower ASA risk factors (P<0.001) and earlier UICC tumor stages (P<0.001) than open resected patients. They also showed reduced overall morbidity (P<0.001), in-hospital mortality (P=0.001), and shorter hospital stays (P<0.001). The rates of intraoperative and specific complications remained unchanged. Nineteen percent of the patients had resections converted to open approaches. These had the highest overall morbidity and longest hospital stays. Their mortality was three times that of the group with complete laparoscopic resection., Conclusions: The open approach remained the standard of surgical care in colon cancer for the study duration. Laparoscopic surgery was used in only a small number of patients. By virtue of preferential patient selection, better early postoperative and long-term results could be achieved for the laparoscopic group than with the open approach. Conversions were shown to be associated with inferior results at the high rate of 19%. To ensure optimal results, laparoscopic surgery for colon carcinoma should be conducted by an experienced surgeon in an appropriately selected patient pool.

From 1/1995 to 8/1997 857 appendectomies were observed in a prospective study. From then on in our clinic has done more laparoscopic then conventional operations, and has developed in the years before a permanent laparoscopic team. For all operations resterilized MIC-instruments are used. Preparation is done with bipolaric instruments and scissor, the appendix stump is supplied a with Röder-sling. The expensive Endo-GIA was used only 3x, if the coecumpole was also inflamed. Because of the fantastic intraabdominal view additional findings quickly be recognized through the laparoscopic method. It was then possible, to plan the therapeutic management exactly. Also variations of the appendix-position are seen clearly and can be operated on without other incisions. There is no significant difference in time between the two methods as we have seen here in practice (35.3 minutes for the conventional and 43.8 for the laparoscopic operation)--they will assimilate, when the surgeon is routine. Fat and muscular patients profit definitely. The problems of wound infection have been rarely observed by the laparoscopic operation. The rate of intraabdominal abscesses was 1.9% and therefore higher as by the conventional method (0.2%). This could be reduced during the period of the study, because we now often lavage and drain. We think that there are no surgical opponent indication to the laparoscopic appendectomy. The reliable conventional technique has to be an obligate technique also in future.