Laparoscopic surgery is the preferred approach for many abdominal procedures because of the reduced postoperative pain, more rapid recovery and improved cosmesis. One of the recent innovations is Single Port/Incision Laparoscopic Surgery (SPILS). The SCARLESS study, funded by the Chief Scientist Office (CSO), aimed to compare the effectiveness of SPILS with standard standard 3-port laparoscopic surgery for appendicectomy. Feasibility measures were collected to assess the viability of a multicentre randomised controlled trial (RCT) to evaluate more complex single port techniques.

A single centre (Aberdeen, UK) RCT was conducted. Seventy nine participants were randomised to receive either SPILS or Standard 3-port laparoscopic surgery and followed-up for six weeks. The primary patient reported outcomes were body image and cosmetic scores at six weeks. The primary clinical outcome was severity of pain at 1 to 7 days.

The study reported at six weeks post operation, SPILS patients answered significantly more favourably to the items in the body image scale and the cosmetic scale compared with patients in the standard group. The duration of operation was shorter in the SPILS group. Patients also required less morphine when in immediate recovery. However, there were no statistically significant differences in other outcomes such as intraoperative and postoperative complications, postoperative analgesia use on ward, length of stay and return to normal activity. It was concluded that patient-reported body image and cosmesis outcomes were better, and surgical outcomes were similar following SPILS. However, the SPILS procedure is more technically demanding and may not be achievable or necessary in routine clinical care. Further assessment of the findings is needed through larger multicentre studies.





Momin Malik, Kirsty McCormack, Zygmunt H Krukowski, Alison McDonald, Gladys McPherson, Jonathan A Cook and Irfan Ahmed for the SCARLESS Study Group.  Single port/incision laparoscopic surgery compared with standard three-port laparoscopic surgery for appendicectomy - a randomised controlled trial.  Trials 2012; 13: 201 

The SCARLESS Study Group. Single port/incision laparoscopic surgery compared with standard 3 port laparoscopic surgery for appendicectomy – A randomised controlled trial. Surgical Endoscopy; 2014