Needlescopic, Laparoscopic, and Open Appendectomy: A Comparative Study

Abstract

The benefits of laparoscopic appendectomy appear to be controversial. Since 1994, several abdominal procedures have been completed by using the needlescopic technique, but there appear to be no prospective studies to demonstrate the perceived benefits of needlescopic appendectomy. The authors compared open, laparoscopic, and needlescopic appendectomy in a randomized fashion with regard to duration of surgery, length of hospitalization, analgesic dosage, and surgery-associated complications. From March to July 1998, 75 patients admitted at the emergency station of the authors' hospital with a final diagnosis of acute appendicitis without tumor formation were randomized to receive one of the three treatment categories: open (OA), laparoscopic (LA), and needlescopic (nLA) appendectomy. Laparoscopic and needlescopic appendectomy were performed by using a three-port technique, although the size of the trocar used varied. There were 26 patients in the OA group, 23 in the LA group, and 26 in the nLA group. The mean operation durations for the OA, LA, and nLA groups were 55.4 +/- 28.0 minutes, 69.1 +/- 48.8 minutes, and 62.3 +/- 26.3 minutes, respectively, and these were not significantly different from one another. The mean number of the analgesic doses (Pethidine 1 mg/kg) required was 1.3 +/- 1.2 mg/kg, 0.5 +/- 0.8 mg/kg, and 0.2 +/- 0.6 mg/kg, respectively. Significant differences were noted when comparing the OA with the LA or nLA groups (OA vs. LA, P = 0.02; OA vs. nLA, P = 0.0002; LA vs. nLA, P = 0.06). The mean oral intake durations were 32.2 +/- 16.9 hours, 21.0 +/- 14.6 hours, and 20.8 +/- 16.4 hours, respectively, after surgery for the OA, LA, and nLA groups, and the between-group differences were statistically significant for the OA versus LA group ( P = 0.004) and for the OA versus nLA group ( P = 0.003). The mean durations of hospitalization for the OA, LA, and nLA groups were 3.6 +/-1.8 days, 2.8 +/- 1.4 days, and 2.4 +/- 0.9 days, and difference was detected between the OA and the nLA groups ( P = 0.02). The OA group rendered a greater wound-complication rate and ileus than did the other two groups, but the differences were not detected between the three categories ( P = 0.065, 0.6935). The result of the current study confirmed that the nLA procedure is a feasible and safe one. The nLA procedure provided substantial advantages over the OA procedure in the contexts of diminished postoperative pain and shorter hospital stay without significant increases in postoperative complication rate or surgical time.

Needlescopic versus laparoscopic cholecystectomy: a prospective study of 60 patients

“…Since then, several technological developments have been achieved, some of them comprising an increasing interest towards attempting to reduce even further the surgical trauma by diminishing the caliber of the instruments. As a result of these initiatives, Gagner and Garcia-Ruiz 2 introduced the term "needlescopic" for operations performed with laparoscopic instruments up to 3 mm in diameter, a definition which has been adopted by other authors 2,3,4 .…”

“…In recent years, an increasing number of papers have advocated this technique as feasible for a variety of abdominal procedures, including appendectomies, adrenalectomies, splenectomies, gastric fundoplications, urologic procedures and cholecystectomies [4][5][6][7] . There is some controversy, though, regarding the benefits of needlescopic cholecystectomy (NC), for some surgeons consider it a natural evolution of LC 8 , while others contend that tissue trauma in needlescopic cholecystectomy (NC) is not significantly reduced, for the 5 mm ports of LC are already minimal and no benefit can be achieved from further reduction.…”

The Quality of Randomized Clinical Trials in the Field of Surgery: Studies on Laparoscopic versus Open Appendectomy as an Example

“…Of these, 7 were omitted (3 were not accessible through the internet network of the university library of Karolinska Institutet and no contact information was available to contact the first authors in order to receive reprints of the papers [4,5,6]; four other studies used the material of an already published RCT [7,8,9,10]). As a result, 42 [11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52] papers remained for inclusion in this study.…”

Cholecystectomy: evolution of laparoscopic approach

“…(2013) считают допу-стимым термин «минилапароскопически ассисти-рованная» ХЭ при совместном применении пяти-миллиметровых и трехмиллиметровых инструмен-тов [23]. Сторонники противоположной позиции полагают, что все инструменты должны быть малого диаметра [111]. Имеется компромиссное мнение от-носительно применения инструментов диаметром менее и более 5 мм во время одной лапароскопи-ческой операции, заключающееся в употреблении термина «комбинированная минилапароскопия» [32].…”