Preliminary Experience of Glove Single Port Laparoscopic Appendectomy in Children and Adolescents for Uncomplicated Appendicitis

Abstract

Background: Laparoscopic appendectomy has been widely applied and became popular procedure for the surgical management of appendicitis. Glove single port laparoscopic appendectomy [GSPLA] is a new technical modification of single incision laparoscopic surgery [SILS]. By this approach the laparoscopic instruments introduced to the abdomen through a longitudinal one umbilical incision only. Purpose: This study aimed to present two centres initial experiences using home-made glove single port for laparoscopic appendectomy [GSPLA] in children and adolescents. Patients and Methods:This prospective study was conducted on patients of pediatric age with uncomplicated appendicitis using GSPLA. This was done through a 2 -cm trans-umbilical longitudinal incision. Then the inner flexible plastic ring (FPR) inside the out folded glove was inserted into the abdominal cavity using a curved artery forceps. The open end of the glove was passed through the rigid outer ring (ROR) where it was stretched and folded several times around the ROR for tightening over the anterior abdominal wall. The fingers of glove act as site for introduction of [laparoscopic instruments, ports and camera.Results: Seventy-two children with acute uncomplicated appendicitis were surgically treated by GSPLA. Their mean age was 13 ± 2.8 years (ranged from 7-16 years). All procedures were completed laparoscopically without conversion. Only two cases were converted to multiport laparoscopic procedure. The operative time was ranged from 35 -79 (mean = 45.24 ± 12.14 min). Post-operative ileus was seen in 2 patients (2.77%) and improved under conservative treatment. No report of umbilical infection or hernia after 6 months of follow up. Conclusion:The GSPLA is a new procedure which is very cheap, easy to be done. In addition to high flexibility and wide range of movement of the instruments in comparison with the other single incision laparoscopic trocar (SILT) devices in the market. Appendectomy is a well-established surgical procedure for the treatment of appendicitis. The operation can be performed as an open surgery or by laparoscopy. A further development in the minimally invasive appendectomy technique has been the introduction of single incision laparoscopic appendectomy (SILAP) [1,2].