Transumbilical Single-Incision Laparoscopic-Assisted Appendectomy (TULAA) is Useful in Adults and Young Adolescents: Comparison with Multi-Port Laparoscopic Appendectomy

Round  1

Reviewer 1 Report

This is an excellent work of interest to surgeons. I enjoy reading it and do agree with the authors on all points. I have no critical comments to make and do hope this manuscript will be made public.

Author Response

I appreciate you for your kind review of my work.

Reviewer 2 Report

Please refer to attached PDF file containing highlights and comments. 

Comments for author File: Comments.pdf

Author Response

Thank you for your detailed review.

We revised the manuscript following your comments.

Corrections were marked with red color.

1. All 'cecectomy' was changed to 'partial cecectomy'.

2. Subgroup analysis was done for the operative time in the IA group. The comparison is clear across both TULAA and MLA. The phrase "for both MLA and TULAA" was added to the sentence.

3. A previous RCT excluded patients with 'BMI > 35' (Carter 2014). We thought that severe obesity might affect operative outcomes as a confound factor.

4. Age criteria were matched for both text and figure.

5. 'about' -> 'generally'

6. 'razor' -> 'razor blade'

7. The sentence, "An operating table was tilted to the Trendelenburg position and rotated to the left side." was rearranged.

8. 'from dirt' was removed.

9. All 'RA' was replaced to 'EA'.

10. 'burying knots beneath the wound' -> 'in a deep dermal fashion'

11. The sentence "Shapiro-Wilk test was performed to test normality of continuous variables. Then, independent t test was used when data is normally distributed, and Mann-Whitney U test was used when data isn’t normally distributed." was added to the 'Statistical analysis' section. In addition, each p-value of continuous variables in tables was replaced and was marked with 'independent t test' or 'Mann-Whitney U test'.

12. The difference of postoperative hospital stay between MLA and TULAA for uncomplicated appendicitis are in the hospital 2-3 days. This is mentioned in the 'Discussion' section, as following phrase "although the difference was little for uncomplicated appendicitis"

13. The sentence "Open conversion was defined as extension of a skin incision more than the designated incision to extract the resected specimen." was added at the end of the 'Operative technique' section. In addition, several changes in the text and in the tables regarding 'open conversion' were marked with red color.

14. Initial, postoperative, and total hospital stays were longer in the MLA group than TULAA group within the interval appendectomy group for complicated appendicitis. The sentence "In addition, the MLA group showed longer initial, postoperative, and total hospital stays than the TULLA group, which might mean that more complicated patients underwent MLA secondary to selection bias." was added to the 'Discussion' section.

15. Line 283-287 in the 'Discussion' section was removed.

16. Line 308-311 was incorported into the next paragraph describing limitations of the study, mentioning selection bias.