1
|
Salö M, Järbur E, Hambraeus M, Ohlsson B, Stenström P, Arnbjörnsson E. Two-trocar appendectomy in children - description of technique and comparison with conventional laparoscopic appendectomy. BMC Surg 2016; 16:52. [PMID: 27491442 PMCID: PMC4973551 DOI: 10.1186/s12893-016-0170-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 07/31/2016] [Indexed: 12/13/2022] Open
Abstract
Background The aim of the study was to describe the technique of two-trocar laparoscopic appendectomy and compare the outcome between two- and three-trocar techniques in children. Methods All children who underwent laparoscopic surgery for suspected appendicitis from 2006 to 2014 in a center for pediatric surgery were included in the study. Converted surgeries and patients with appendiceal abscess or concomitant intestinal obstruction were excluded. A total of 259 children underwent appendectomy with either two (35 %) or three (65 %) laparoscopic trocars according to the surgeons’ preference and intraoperative judgment. Patient demographics, clinical symptoms, surgery characteristics, and complications were reviewed. Results The mean age of the children was 10.4 years (range, 1–14 years). The mean follow-up time was 41.2 months (SD ± 29.2). No significant differences in age, gender, weight, or signs and symptoms were found between the two- and three-trocar groups. The mean surgery time was significantly shorter in the two-trocar group (47 min) than in the three-trocar group (66 min; p < 0.001). The rates of surgical complications were 2 % vs. 4 %, (p = 0.501), and the rates of postoperative complications were 0 % vs. 5 % (p = 0.054), in the two- and three-trocar groups. The overall incidence of postoperative wound infection was low (<1 %) and did not differ between groups. Conclusions Two-trocar laparoscopic appendectomy seems to be a safe and feasible technique with a low rate of postoperative wound infections. The present findings demonstrate that when the two-trocar technique could be applied, it is a good complement to the conventional three-trocar technique.
Collapse
Affiliation(s)
- Martin Salö
- Department of Clinical Sciences, Pediatrics, and Department of Pediatric Surgery, Lund University, Skåne University Hospital, Lasarettsgatan 48, Lund, 221 85, Sweden.
| | - Emil Järbur
- Department of Clinical Sciences, Pediatrics, and Department of Pediatric Surgery, Lund University, Skåne University Hospital, Lasarettsgatan 48, Lund, 221 85, Sweden
| | - Mette Hambraeus
- Department of Clinical Sciences, Pediatrics, and Department of Pediatric Surgery, Lund University, Skåne University Hospital, Lasarettsgatan 48, Lund, 221 85, Sweden
| | - Bodil Ohlsson
- Department of Clinical Sciences, and Division of Internal Medicine, Lund University, Skåne University Hospital, Malmö, 205 02, Sweden
| | - Pernilla Stenström
- Department of Clinical Sciences, Pediatrics, and Department of Pediatric Surgery, Lund University, Skåne University Hospital, Lasarettsgatan 48, Lund, 221 85, Sweden
| | - Einar Arnbjörnsson
- Department of Clinical Sciences, Pediatrics, and Department of Pediatric Surgery, Lund University, Skåne University Hospital, Lasarettsgatan 48, Lund, 221 85, Sweden
| |
Collapse
|
2
|
One, two or three port appendectomy - a rational approach. Wideochir Inne Tech Maloinwazyjne 2013; 8:226-31. [PMID: 24130637 PMCID: PMC3796724 DOI: 10.5114/wiitm.2011.33991] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2012] [Revised: 01/12/2013] [Accepted: 02/02/2013] [Indexed: 11/23/2022] Open
Abstract
Introduction Laparoscopic appendectomy is a safe and feasible technique accepted by many surgeons as the gold standard approach for the treatment of acute appendicitis in children. Traditionally laparoscopic appendectomy requires the use of three ports. However, surgical techniques with fewer ports have been reported. Aim To evaluate the efficacy of laparoscopic appendectomy in children according to the proposed 3-step protocol using one, two or three ports. Material and methods A total of 100 children with the diagnosis of acute appendicitis underwent laparoscopic appendectomy. Patients were treated according to the following protocol: transumbilical access with one 10 mm port using the laparoscope with working channel. The appendix was mobilized and delivered through the umbilical port and tied extracorporeally and removed. If the appendix was placed retrocecally or had adhesions, a second port was introduced. The appendix was mobilized and finally retrieved from the abdominal cavity through the camera port, and resected extracorporeally. In the cases of very short and gangrenous appendix and immobile colon, a third port was introduced and totally intra-abdominal appendectomy was performed. Patients were evaluated regarding the duration of the operation, and operative and postoperative complications. Results During the study period 100 children (58 males, 42 females) had laparoscopic appendectomy: 48 children by one-port technique (group I), 27 children by two-port technique (group II) and 25 children by three-port technique (group III). The mean operative time was 33 min (20-55 min) in group I, 39 min in group II (23-60 min), and 49 min (30-75 min) in group III. There were no intraoperative complications. Wound infections were recorded in 4 (8.3%) patients in group I, three (11.1%) in group II and four (16.0%) in group III. One patient in group III developed an abdominal abscess managed conservatively. Conclusions One-port laparoscopic appendectomy is a feasible technique in children. It allows 48% of children to have the operation. The addition of a second port allows one to mobilize the appendix and perform extracorporeal resection in an additional 27% of cases. These approaches have shorter operative time compared to 3-port technique. Laparoscopic extracorporeal appendectomy, especially one-port, is found to be cost effective and have excellent cosmetic results.
Collapse
|
3
|
Lee JS, Choi YI, Lim SH, Hong TH. Transumbilical single port laparoscopic appendectomy using basic equipment: a comparison with the three ports method. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2012; 83:212-7. [PMID: 23091793 PMCID: PMC3467387 DOI: 10.4174/jkss.2012.83.4.212] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Revised: 07/19/2012] [Accepted: 07/30/2012] [Indexed: 02/02/2023]
Abstract
PURPOSE Single port laparoscopic surgery is a rapidly evolving laparoscopic surgical approach. We report a comparison of transumbilical single port laparoscopic appendectomy (TUSPLA) and conventional laparoscopic appendectomy (CLA) in a Korean military hospital. METHODS This single-center retrospective study of 63 patients who received laparoscopic appendectomy was conducted between May 2011 and October 2011. Nineteen patients received TUSPLA and 44 patients received CLA. Clinical outcomes such as operation time, hospital stay, postoperative pain, diet, and postoperative complication were reviewed. RESULTS There were no statistically significant differences between TUSPLA and CLA patients, respectively, in operation time (58.9 minutes vs. 52.3 minutes, P = 0.262), duration of hospitalization (10.2 days vs. 10.6 days, P = 0.782), mean visual analogue scale score (2.6 vs. 2.5, P = 0.894), and return to diet (1.6 days vs. 1.7 days, P = 0.776). There were two cases (10.5%) of short-term complications in the TUSPLA group and four cases (9.1%) of short-term complications in the CLA group. All patients were fully recovered at discharge. CONCLUSION TUSPLA is a feasible alternative for CLA. When a glove port is used, no special instruments are needed. Thus, it can be performed in a hospital equipped with basic laparoscopic surgical instruments.
Collapse
Affiliation(s)
- Jun Suh Lee
- Department of Surgery, The Armed Forces Capital Hospital, Seongnam, Korea
| | | | | | | |
Collapse
|
4
|
Comparative study on surgical outcomes and operative costs of transumbilical single-port laparoscopic appendectomy versus conventional laparoscopic appendectomy in adult patients. Surg Laparosc Endosc Percutan Tech 2011; 19:493-6. [PMID: 20027094 DOI: 10.1097/sle.0b013e3181c15493] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE To reduce the incisional morbidity and improve cosmesis, the authors adopted a single-port laparoscopic appendectomy using a unique "single-port". The authors retrospectively evaluated transumbilical single-port laparoscopic appendectomy (TUSPLA) against conventional laparoscopic appendectomy (CLA) with respect to perioperative outcomes and operative cost in the adult patients. MATERIALS AND METHODS The authors reviewed the case of laparoscopic appendectomy between April 2008 and January 2009. Demographic data, operating time, pathology of appendix, hospital stay, surgical morbidities, visual analogue scale pain scores, analgesics requirements, and the operative cost were compared. RESULTS Seventy-two underwent TUSPLA and 108 underwent CLA. There were more females in the TUSPLA group. Surgical outcomes were similar between the TUSPLA and the CLA group. Operative cost was significantly lower in the TUSPLA group compared with the CLA group. CONCLUSIONS This study showed that TUSPLA was cost saving and produced similar surgical outcomes in selected appendicitis patients compared with CLA.
Collapse
|
5
|
Yagnik VD, Rathod JB, Phatak AG. A retrospective study of two-port appendectomy and its comparison with open appendectomy and three-port appendectomy. Saudi J Gastroenterol 2010; 16:268-71. [PMID: 20871191 PMCID: PMC2995095 DOI: 10.4103/1319-3767.70611] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND/AIMS To establish the efficacy of two-port appendectomy as an alternative to standard laparoscopic and open appendectomy in the management of acute appendicitis. MATERIALS AND METHODS Of the 151 patients included in the study, 47 patients were in the open group, 61 in two-port and 43 patients were included in the three-port group. Only patients with uncomplicated acute appendicitis were included in the study. Patients with complicated appendicitis like perforated appendix, appendicular lump and appendicular abscess were excluded from the study. Patients converted to open procedure after initial diagnosis and patients with other pathology in addition to appendicitis were also excluded. Patients with recurrent appendicitis and chronic appendicitis were excluded. The total number of excluded cases was 50. Data were compared with cases of open and three-port appendectomy. RESULTS The mean operative time was 43.94, 35.74, and 59.65 min (SD: 18.91, 11.06, 19.29) for open, two-port, and three-port appendectomy groups respectively. Mean length of stay in days was 3.02, 1.93, and 2.26 (SD: 1.27, 1.04, 1.09) for open, two-port, and three-port appendectomy groups respectively. Surgical site infection was significantly lower (P = 0.03) in laparoscopy group as compared to that in open appendectomy group. Seven patients (4.63%) developed surgical site infection, 5 (10.63%) in the open and 2 (1.92%) in the laparoscopy group. Surgical site infection was 1.63% and 2.32% in two-port and three-port appendectomy groups respectively. CONCLUSIONS For uncomplicated appendicitis, the two-port appendectomy technique significantly reduces operative time as well as length of hospital stay. It also reduces surgical site infection as compared to open appendectomy group.
Collapse
Affiliation(s)
- Vipul D. Yagnik
- Department of Surgery, Pramukh Swami Medical College, Shree Krishna Hospital, Karamsad - 388325, Gujarat, India,Address for correspondence: Dr. Vipul D. Yagnik, 77, Siddhraj Nagar, Station Road, Patan-384265, Gujarat, India. E-mail:
| | - Jignesh B. Rathod
- Department of Surgery, Pramukh Swami Medical College, Shree Krishna Hospital, Karamsad - 388325, Gujarat, India
| | - Ajay G. Phatak
- Department of Surgery, Pramukh Swami Medical College, Shree Krishna Hospital, Karamsad - 388325, Gujarat, India
| |
Collapse
|
6
|
Malik AM, Talpur AH, Laghari AA. Video-assisted laparoscopic extracorporeal appendectomy versus open appendectomy. J Laparoendosc Adv Surg Tech A 2009; 19:355-9. [PMID: 19397395 DOI: 10.1089/lap.2008.0303] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Laparoscopic appendectomy (LA) is categorized into intracorporeal appendectomy (ICA) and video-assisted extracorporeal appendectomy (VAECA). This study is conducted to compare feasibility and effectiveness of video-assisted extracorporeal appendectomy (VAECA) with open appendectomy (OA). PATIENTS AND METHODS This was a comparative descriptive study conducted at the Department of Surgery of Liaquat University of Medical and Health Sciences (Jamshoro, Pakistan) from June 2003 to November 2007. Two hundred and eighty-three patients of acute appendicitis were included and categorized into two groups: A and B. Group A included 150 (53%) patients operated on by the OA technique, while group B included 133 (47%) patients in whom VAECA was performed. VAECA was accomplished through three ports in the majority of patients (89%), while a few cases (11%) were completed by two ports only. Patients below 10 years of age and with suspected appendicular mass were excluded from the study. Both operative techniques and their merits and demerits were explained to all the patients and, depending upon their choice or by a simple flip of a coin, they were operated on by either of the techniques. A well-informed written consent was also taken from every patient. The results of both the groups were collected on a proforma and were compared in terms of cosmesis, total operative time, operative and postoperative complications, and total duration of hospital stay. RESULTS The mean operating time was much shorter in group B (p < 0.001), compared to group A patients. The incidence of postoperative infection was comparatively higher in OA, compared to VAECA. The rate of operative complications (p < 0.001), postoperative complications (p < 0.01), and duration of hospital stay (p < 0.001) were all significantly lower in the VAECA group. Cosmetic results were excellent in VAECA, compared to OA, as assessed by length of incision and the postoperative scar formation. CONCLUSION VAECA can be a good alternate option in simple cases without much adhesions or mass formation.
Collapse
Affiliation(s)
- Arshad M Malik
- Department of Surgery, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan.
| | | | | |
Collapse
|
7
|
Hong TH, Kim HL, Lee YS, Kim JJ, Lee KH, You YK, Oh SJ, Park SM. Transumbilical Single-Port Laparoscopic Appendectomy (TUSPLA): Scarless Intracorporeal Appendectomy. J Laparoendosc Adv Surg Tech A 2009; 19:75-8. [PMID: 19196084 DOI: 10.1089/lap.2008.0338] [Citation(s) in RCA: 101] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Tae Ho Hong
- Department of Surgery, Incheon St. Mary Hospital College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Hyung Lan Kim
- Department of Surgery, Incheon St. Mary Hospital College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Yoon Suk Lee
- Department of Surgery, Incheon St. Mary Hospital College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Jin Jo Kim
- Department of Surgery, Incheon St. Mary Hospital College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Keun Ho Lee
- Department of Surgery, Incheon St. Mary Hospital College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Young Kyoung You
- Department of Surgery, Incheon St. Mary Hospital College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Se Jeong Oh
- Department of Surgery, Incheon St. Mary Hospital College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Seung Man Park
- Department of Surgery, Incheon St. Mary Hospital College of Medicine, The Catholic University of Korea, Incheon, Korea
| |
Collapse
|
8
|
|
9
|
Koontz CS, Smith LA, Burkholder HC, Higdon K, Aderhold R, Carr M. Video-assisted transumbilical appendectomy in children. J Pediatr Surg 2006; 41:710-2. [PMID: 16567181 DOI: 10.1016/j.jpedsurg.2005.12.014] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Video-assisted transumbilical appendectomy (VATA) is a combination of laparoscopic and open techniques and is not widely used in children. We are reporting our most recent experience with this technique. METHODS After the institutional review board approval, the charts of patients who underwent VATA between December 2003 and October 2004 were retrospectively reviewed. All children presenting with a preoperative diagnosis of appendicitis were candidates. A 10-mm trocar was placed in the umbilicus. An operating laparoscope was used for mobilizing the appendix. The appendix was delivered through the umbilicus. A standard extracorporeal appendectomy was performed. The umbilical ring was closed and the wound irrigated. Demographic and outcome data were collected and is presented as mean +/- SD. RESULTS Sixty-one males and 50 females underwent VATA (n = 111). Age and weight were 11 +/- 3.2 years and 49 +/- 22 kg, respectively. Six patients had previous abdominal surgery. Operative time was 36 +/- 24 minutes (range, 9-140 minutes). An additional trocar was placed in 2 patients, and 2 patients were converted to open. Five patients had additional procedures. Appendicitis was classified intraoperatively as acute (n = 44), suppurative (n = 5), gangrenous (n = 8), ruptured (n = 30), appendiceal colic (n = 13), and other (n = 11). Preoperative antibiotics were given to 95 patients and were continued in 35 patients postoperatively. Length of stay was 1.8 +/- 1.7 days (range, 1-11 days). Length of follow-up was 13 +/- 6.3 days (n = 90). Complications included intra-abdominal abscess (n = 1) and wound infection (n = 7). CONCLUSIONS Video-assisted transumbilical appendectomy minimizes equipment needs, thus, potentially reducing cost. Simple and complex appendectomies can be performed even if the patient has had previous abdominal surgery. Our complication rate was low, and our operating times and length of stay were short. Video-assisted transumbilical appendectomy is a safe and effective technique in children and can be used in lieu of the 3-trocar laparoscopic technique.
Collapse
Affiliation(s)
- Curt S Koontz
- Department of Surgery, University of Tennessee College of Medicine, Chattanooga Unit, Chattanooga, TN 37403, USA
| | | | | | | | | | | |
Collapse
|
10
|
Ghezzi F, Raio L, Mueller MD, Franchi M. Laparoscopic appendectomy: a gynecological approach. Surg Laparosc Endosc Percutan Tech 2003; 13:257-60. [PMID: 12960789 DOI: 10.1097/00129689-200308000-00007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The removal of surgical specimen at operative laparoscopy through an incision of the posterior fornix is frequently performed for the removal of pelvic masses of the internal genital tract. We present a technique for the removal of the appendix through a laparoscopic colpotomy. Eight patients who underwent laparoscopy for a suspected pelvic or adnexal disease and intraoperatively found to be affected by an appendicular disease were included in the present series. After intrabdominal dissection, the appendix was removed from the abdomen transvaginally through a laparoscopic colpotomy. The median range of the operation was 45 minutes (range 25-95). There were no intraoperative complications. The postoperative hospitalization period ranged from 2 to 7 days. Vaginal spotting was present in one case and lasted 24 hours. At follow-up visit, no patients complained of pelvic pain or dyspareunia. Vaginal wall induration was not found in any of the patients at pelvic examination. The removal of the appendix through a posterior colpotomy after laparoscopic appendectomy is simple, safe, feasible, well tolerated, and can be considered a valid alternative to other methods.
Collapse
Affiliation(s)
- Fabio Ghezzi
- Department of Obstetrics and Gynecology, University of Insubria-Del Ponte Hospital, Varese, Italy.
| | | | | | | |
Collapse
|