- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03106467
Practical Advantages of Single-port Over Three-port Laparoscopic Appendectomy in Children (PASTA)
Practical Advantages of Single-port Over Conventional Three-port Laparoscopic Appendectomy in Children: A Randomized Controlled Trial of 400 Cases
Despite growing popularity, practical advantages of single-port laparoscopic appendectomy (SLA) over conventional three-port laparoscopic appendectomy (CLA) have yet to be established well in pediatric population.
The investigators designed the randomized controlled trial to clarify practical advantages of SLA over CLA in pediatric population. The investigators compared conversion rate, intra-operative adverse events, operating time, wound complications, intra-abdominal complications, and postoperative hospital stay, changes in postoperative pain severity, and cosmetic outcomes during follow up period between SLA and CLA groups.
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Currently the single-port laparoscopic appendectomy (SLA) has gained popularity in pediatric population since it was first reported in 1998 by Esposito et al. Nonetheless, the practical advantages of SLA over conventional three-port laparoscopic appendectomy (CLA) have yet to be established well in pediatric population due to lacking and inconsistent high-level evidences from randomized trials and meta-analysis.
Thus far, in addition to overall postoperative hospital stay, complications such as wound abscess and seroma, intra-abdominal abscess and ileus were reported not to be significantly different between SLA and CLA, while SLA might have taken longer operation time in children and adult. Currently, the advertised benefits on postoperative pain and cosmetic results of SLA incurred suspicion because of heterogeneous data inconsistently supporting SLA from a few RCTs especially in pediatric population. Consequently, a consensus regarding the practical superiority of SLA to CLA has still not been reached particularly in children.
To address this issue, the investigators designed the randomized trial to clarify practical benefits of SLA over CLA in pediatric population. For this, the investigators compared conversion rate, intra-operative adverse events, operating time, wound complications, intra-abdominal complications, and postoperative hospital stay, changes in postoperative pain severity, and cosmetic outcomes during follow up period between SLA and CLA groups. Primary end points were postoperative pain severity and cosmetic satisfaction. Secondary endpoints were intra- and post-operative complication rates, operation time, and postoperative hospital stay.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
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Gyeonggi-do
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Anyang-si, Gyeonggi-do, Korea, Republic of, 14068
- Hallym University Sacred Heart Hospital
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Acute appendicitis was diagnosed in accordance with following clinical, laboratory, and radiographic criteria; history of right lower quadrant pain or periumbilical pain migrating to the right lower quadrant with nausea and/or vomiting. presence direct and indirect tenderness on McBurney's point and/or right lower quadrant guarding. a fever ≥ 38°C and/or white blood cell counts more than 10X10³ cells per mL on complete blood count. diameter of appendix ≥ 6 mm with mural thickening and periappendiceal fat infiltration and/or abdominal fluid collection on appendiceal ultrasonography or abdominopelvic computed tomography.
- Perforated appendicitis: disrupted appendix contour with non-homogenous peritoneal fluid collection in pelvic cavity and/or sub-hepatic space simultaneously with above mentioned clinical, laboratory, and radiographic findings of appendicitis.
- Peri-appendiceal abscess which was preoperatively confirmed by ultrasonographic and/or computed tomographic evidence.
Exclusion Criteria:
- Suspicious diagnosis of appendicitis which was not in accordance with the diagnosis criteria.
- Patients who were subjected to ≥ 2 days of empirical antibiotics therapy for initial symptom prior to diagnosis with acute appendicitis.
- History of coagulation disorders, shock upon admission, previous abdominal surgery, contraindication to general anesthesia, suspected or proven malignancy, and mental illness.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Single-port laparoscopic appendectomy
Single-port laparoscopic appendectomy is performed through single-port which is installed in umbilicus.
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Single-port laparoscopic appendectomy: A 1.5 cm skin incision is made inside the umbilicus and single port is introduced through it.
The appendix is manipulated by a combination of a 5-mm scope, angulated, and straight instruments.
The periappendiceal vessels and appendix are ligated and divided.
Specimen is delivered via the transumbilical port.
Umbilical fascia and skin are routinely closed.
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Active Comparator: Three-port laparoscopic appendectomy
Three-port laparoscopic appendectomy is performed using conventional three-port technique which needs two additional ports outside umbilicus in addition to trans-umbilical port
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Three-port laparoscopic appendectomy: CLA requires the introduction of a 30-degree 5-mm or 10-mm rigid scope through a 0.5 - 1.0 cm intra umbilical incision.
Two additional 5-mm incisions are made outside umbilicus.
Appendectomy is performed in the same manner as described for the SLA above.
The umbilical fascia and skin are routinely closed.
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Post-operative pain (visual analogue scale of pain ranging 0-10)
Time Frame: up to postoperative day 7
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Post-operative pain is measured by visual analogue scale of pain ranging 0-10.
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up to postoperative day 7
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Cosmetic satisfaction (visual analogue scale of cosmetic result ranging 1-10)
Time Frame: at postoperative 12 months
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Cosmetic satisfaction is measured by visual analogue scale of cosmetic result ranging 1-10.
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at postoperative 12 months
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Wound complications
Time Frame: up to postoperative 3 months
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Wound complications include port site seroma collection and abscess formation.
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up to postoperative 3 months
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Intra-abdominal complications
Time Frame: up to postoperative 3 months
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Intra-abdominal complications include radiologically confirmed bowel ileus or peritoneal abscess formation.
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up to postoperative 3 months
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Operation time
Time Frame: on postoperative day 1
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OT is defined as the duration of surgery, from skin incision to application of wound dressing.
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on postoperative day 1
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Post-operative hospital stay
Time Frame: at postoperative 2 weeks
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Post-operative hospital stay is the days between a day after surgery and discharge.
Operation day is considered as day 0.
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at postoperative 2 weeks
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Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Soo Min Ahn, MD, Division of Pediatric Surgery, Hallym University Sacred Heart Hospital
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- 2014-I124
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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Myongji HospitalUnknown
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Associazione Chirurghi Ospedalieri ItalianiSocietà Italiana di Chirurgia Endoscopica e nuove tecnologie (SICE)Unknown