Two-port vs. three-port laparoscopic appendicectomy: A bridge to least invasive surgery

Abstract

INTRODUCTION:The conventional three-port technique for laparoscopic appendicectomy has proven its worth in the management of appendicular pathologies. From a cosmetic viewpoint, the umbilical and suprapubic port-sites are hidden by natural camouflages, the right Iliac fossa (RIF) port is the only visible external sign of surgery. The two-port technique avoids even this marker of abdominal invasion. In this study, we describe the technique of two-port laparoscopic appendicectomy (TPA) and compare it with conventional laparoscopic appendicectomy (CLA).MATERIALS AND METHODS:All patients studied underwent operation for acute appendicitis during a 6-month period. Data were collected prospectively for the TPA and retrospectively for the CLA. The TPA was performed with one 10 mm umbilical working port and one 5 mm suprapubic camera port. A hypodermic needle was introduced in the RIF to retract the appendix. The appendicular artery was controlled with diathermy or ultrasonic shears. The base was ligated with a loop knotted extracorporeally. CLA was performed via the conventional 10 mm umbilical, 5 mm suprapubic and 5 mm RIF ports. The appendicular stump was ligated with an endoloop or an intracorporeal knot.RESULTS:A total of 146 patients underwent surgery over the 6-month period for appendicitis. Out of 62 cases attempted, the TPA was successful in 51 cases, with conversion to the three-port technique in 11. The operative time, complication rates, return to work were comparable between the two groups. Patients who had TPA had a shorter postoperative stay.CONCLUSION:This is an initial experience with TPA. There is little difference in the operative time, postoperative stay and complications rates between this technique and the conventional three-port one. There is hence little to be lost and a likely benefit to be gained by performing the TPA although a randomised study is necessary.

Two Port Laparoscopic Appendicectomy – An Alternative to Sils and Notes

“…2 TLA has an advantage over SILS and NOTES in being safe, easy, feasible, not requiring specialized instruments and also economical. 11 TLA is a safe and feasible in children with the operative time and post-operative complications being the same to that of CLA. 12 CONCLUSION: Two port Laparoscopic appendicectomy is safe, cost-effective, cosmetically effective, easy to learn and perform.…”

“…10 Two-port Laparoscopic Appendectomy (TLA) has all the advantages of Conventional Laparoscopic Appendectomy (CLA) with significantly reduced operative time and cost. Ours is modified technique of Ashwin Rammohan et al 11 The needle with loop retractor has an added merit of holding the appendix even with extensive inflammation, enables the surgeon for stable manipulation and gives better counter-traction than conventional forceps 11 . Also with the intraoperative view the surgeon can decide the best site for placement of the needle-loop which is ergonomically and cosmetically suitable 11 .…”

Conventional laparoscopic appendectomy versus double‐incision, three‐port laparoscopic appendectomy: A 1‐year randomized controlled trial

“…However, SILS has several limitations: it is difficult to perform, requires a bigger umbilical incision, carries a high risk of port-site incisional hernia, has a longer duration of surgery, and presents a steep learning curve (8,9,13). As a bridge between CLA and SILS, numerous studies have been done in which the number of ports has been reduced; they have also compared CLA and SILS to port exteriorization appendectomy, needlescopic appendectomy, extracorporeal appendectomy, laparoscope-assisted appendectomy, and needle loop retractor appendectomy (6,(14)(15)(16). The present study similarly compared CLA to DILA, but there was no reduction in the number of ports.…”

“…In the CLA group, 55.2% of the patients were women, and in the DILA group, 64.5% were; this difference was not statistically significant (P = 0.460). In a study that used a hypodermic needle to extracorporeally ligate the base of the appendix, Rammohan et al reported a higher proportion of women (55%) than men (16). In a study of 248 patients comparing single-port LA to CLA, 37.9% of patients had acute appendicitis and 32.6% had acute suppurative appendicitis (19).…”

“…In the present study, the mean operation time of 27.6 min in the DILA group was longer than that in the CLA group, but it was shorter than that reported in other studies of DILA. One study had a mean operative time of 35.74 min during extracorporeal ligation of the appendix (6), and another had a mean operative time of 55.7 min when a needle loop retractor was used to retract and manipulate the appendix at McBurney's point (16). When Donmez et al introduced a needle grasper device at McBurney's point to hold the appendix, the procedure took 57.03 min (14).…”