Laparoscope-assisted appendectomy in adults: the two-trocar technique

Abstract

BACKGROUNDOpen appendectomy is still the most common method of treating appendicitis. Laparoscopic procedures for removal of the appendix by the “in” technique as an alternative to conventional appendectomy have gained wide popularity, but have been criticized for their technical difficulty and high cost. We assessed the safety and efficacy of the laparoscope-assisted appendectomy (the two-trocar technique) in adults.PATIENTS AND METHODSWe retrospectively studied 129 patients who had appendectomy using the laparoscope-assisted two-trocar technique between July 2002 to December 2003. The procedures were done by consultants and surgeons-in-training with experience in minimally invasive and open techniques. Locally modified endoloop and reusable trocars were used to reduce the cost. Appendectomy was performed extra-abdominally after the appendix was identified by using a laparoscope through one port and then delivered outside through the second port using reusable laparoscopy instruments.RESULTSThe two-trocar technique was successful in 101 (78.3%) cases; 14 (10.8%) needed a third trocar to complete the operation extra-abdominally, 6 (4.6%) were converted to open surgery, and 5 (3.8%) had an intra-abdominal laparoscopic appendectomy. The mean operation time was 35 minutes (range, 30–90 minutes). Six cases (4.6%) had infection. The mean hospital stay was 2.8 days (range, 2–7 days). No case of port hernia was reported during the follow-up period (range, 14–30 months).CONCLUSIONThe laparoscope-assisted two-trocar technique for removal of the appendix can be performed as safely and efficiently as the open technique, but at a lower cost than the complete laparoscopic ‘in” method and does not need much technical expertise. This method is recommended as an alternative procedure to open appendectomy or the complete laparoscopic “in” technique in adults.

Conventional Laparoscopic Appendicectomy and Laparoscope-Assisted Appendicectomy: a Comparative Study

“…Laparoscopic procedures for removal of the appendix by the three-port technique as an alternative to conventional appendicectomy have gained wide popularity, but they have been criticized for its technical difficulty, high cost, and more time consumption [1]. We have compared the conventional laparoscopic appendicectomy (LA) and laparoscope-assisted appendicectomy (LAA).…”

Port extériorisation appendectomy—our experience

“…2 Should one encounter an appendicular mass it is best left alone for a later date as fine dissection of such a friable mass needs either an outstanding experience in laparoscopic surgery or the tactile feed back provided by fingers, as in open surgery.…”

“…2,10 Laparoscopic appendectomy has Appendix pulled out of right iliac fossa port emerged as a viable treatment option not only because of patients' demands for better cosmesis/lesser pain but also because of surgeons' concerns based on diagnostic ambiguity and anatomical variability. 2 Our experience reiterates these advantages. In one of five cases the diagnosis turned out to be otherwise despite an unequivocal clinical score and in another 11.55% the appendix turned out to be sub-hepatic.…”

“…1,2 Harmonic scalpel would be ideal for such dissections but use monopolar cautery, though controversial, was found safe and effective enough. 2,11 We utilised the conventional cautery for laparoscopic work by getting into contact the metallic tip of conventional cautery lead with the metallic knob provided for cautery attachment in laparoscopic instruments (Figure 7).…”

A comparative study between single incision laparoscopic appendectomy and conventional laparoscopic appendectomy

“…[3][4][5][6] With the advent of minimal invasive surgery, the number of ports has been reduced to further improve cosmetic outcome. [7][8][9] Single port laparoscopic appendectomy that requires only a single incision is becoming more popular. This surgical approach provides a number of advantages, including improved aesthetics (a single umbilical incision), lower risk of injury to abdominal muscle vessels, less postoperative pain and the possibility of converting to the conventional laparoscopic procedure (combined trocars) if necessary.…”