Easily Applicable Single-incision Laparoscopic Appendectomy Using Straightforward Instrumental Alignment and Conventional Laparoscopic Instruments

Abstract

Background: Laparoscopic appendectomy is one of the most frequently performed operations. As such, single-incision laparoscopic appendectomy (SILA) is indicated as a feasible and safe procedure comparable to conventional laparoscopic appendectomy (CLA). However, novice surgeons face challenges in performing SILA, because the role of the surgeon's hands is reversed. We introduce an easily applicable technique of SILA by adapting the alignment of CLA.Methods: A series of 61 consecutive patients underwent SILA between January 2019 and December 2019 by 4 surgeons at Bundang CHA Medical Center. Acute appendicitis was diagnosed preoperatively by abdomino-pelvis computed tomography or ultrasonography. During the operation, a 3-channel Glove port was used with conventional laparoscopic instruments. Results:The study participants consisted of 32 males and 29 females, with a mean age of 26.8 years (range, 4 to 66 y). The mean body mass index was 20.79 kg/m 2 (range, 11.89 to 27.04 kg/m 2 ). The mean operation time was 37.5 ± 17.0 minutes. There was only 1 case of conversion with 1 additional port. Eight patients (13.1%) experienced postoperative complications defined by Dindo-Clavien-Strasberg classification: grade 1 wound complication in 7 patients and grade 2 postoperative bowel obstruction in 1 patient. The mean postoperative hospital stay was 2.5 ± 1.3 days. Conclusion:Alignment of the instruments during CLA was successfully implemented into a SILA. Our new, easily applicable SILA technique will decrease the learning curve for novice surgeons in performing single-incision laparoscopic surgery.

A brief overview of single-port laparoscopic appendectomy as an optimal surgical procedure for patients with acute appendicitis: still a long way to go

“…Finally, 17 research articles or case series on SPLA, from the Republic of Korea, China, India, Spain, and other countries, were included in the present review. [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] Most articles were from the Republic of Korea (n ¼ 6), followed by China (n ¼ 4), India (n ¼ 3), Vietnam (n ¼ 1), Argentina (n ¼ 1), Egypt (n ¼ 1), and Spain (n ¼ 1). There were eight retrospective studies, six prospective studies, and three case series (Figure 1).…”

“…Surgical techniques, equipment, and devices, including magnet-assisted single trocar (MAST), needle grasper (Endo Relief)-assisted single-incision laparoscopic appendectomy (NASILA), and SPLA using a needle-type grasping forceps (SLAN) are summarized (Table 1). [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] The performance of each technique was also compared in terms of clinical outcomes (Table 2).…”

“…Although the average NASILA operating time was shorter than SLAN (37.1 and 43.3 min versus 66.25 min), their average incision was longer (1.2 and 1.8 cm versus 1.0 cm); and other postoperative clinical outcomes showed no significant differences. The protocol described by Chong et al 21 did not use additional instruments, with lower cost and shorter operating time (37.5 min); however, it resulted in negative clinical outcomes, such as longer surgical incision (2.5 cm) and higher surgical site infection rate (11.5%); notably, postoperative intestinal obstruction was found in one case (1.6%). Thus, this technique still has room for improvement.…”

“…The techniques described by Uday et al, 22,23 Muneef et al, 24 and Lee et al 25 may also be performed using conventional instruments, which are more acceptable in price, however, incisions of 2-2.5 cm don't satisfy the requirements of modern minimally-invasive surgeries. Similarly, Chong et al 21 directly applied the instruments and methods of three-port techniques to single-port laparoscopic surgery, during which a comfortable 'triangle relationship' angle was created. This new technique reduces the learning curve, but its high rate of complications (13.1%) remains a concern.…”

Wound Irrigation Using Wet Gauze May Reduce Surgical Site Infection Following Laparoscopic Appendectomy

“…Surgeons tend to use less invasive techniques when managing acute appendicitis. Although single-incision LA is more attractive due to less abdominal wall trauma, faster recovery ( 24 ), and better cosmetic results compared to CLA ( 15 ). Moreover, Markar et al ( 25 ) found in their meta-analysis that the incidence of wound infection was reported in all the included studies, with 4% in each group and no statistical difference between the two techniques.…”