Mini-Incision Open Appendectomy with Incision Skin Tissue Retractor vs. Laparoscopic Appendectomy: A Retrospective Study of the Management of Child Acute Appendicitis

Li, Xian-Ling; Zhang, Qinming; Zhang, Weiping; T, Liu

doi:10.1007/s12325-018-0829-3

Cited by 3 publications

(1 citation statement)

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“…The decision to operate or not to operate on these patients should remain in the hands of the consulted surgeon; however, this decision may be made in the future by ER physicians, and surgery is challenged by the alternative of avoiding a procedure at all. LA certainly offers a better choice for patients when compared to open appendectomy, but there are several options to improve the standard operative technique aiming for a less invasive procedure including mini-incision and hybrid appendectomy [22, 23]. SILS, NOTES, and robotic assisted appendectomy have been shown to be feasible but are not universally available, increase costs, and do not make incisions smaller [11, 14, 24].…”

Section: Discussionmentioning

confidence: 99%

Development of a Two Port Laparoscopic Appendectomy Technique at a Rural Hospital

Bonatti

2019

Minimally Invasive Surgery

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Background. Laparoscopic appendectomy (LA) is most commonly performed using two 5-mm and one 10/12-mm ports. Various attempts to reduce the number and size of ports have been made and new technologies such as single port LA have been introduced. Appendix and mesoappendix are usually divided with a stapler or energy device with electrocautery, clips, and endoloop being cheaper options. Patients and Methods. This study includes 51 consecutive LAs performed at a rural hospital. Patients were divided into 4 groups: group 1 was the standard technique group (n=12), group 2 served as a “try-out” (n=12), group 3 served as feasibility group (n=12), and group 4 was the final patient cohort in which the optimized technique was preferably used (n=15). Results. Median age of the study cohort was 35.4 (range: 6.2-80.6) years, and 55% of patients were male. Whereas in G1 all patients had standard port placement (10/12-mm, 2x5-mm), in an increasing number of patients in G2-4 only two 5-mm ports and the 2.3-mm Teleflex minigrasper were inserted. Usage of staplers and/or energy devices was reduced from 100% in G1 to 20% in G4, and in the majority of cases both the appendix and the vascular pedicle were secured with an endoloop. The new technique did not add time to the procedure or total OR time. No stump-leaks or surgical site infections were encountered in this series, and there were no conversions to open surgery. Cost savings when not using a stapler or energy device are approximately 400$ per case; the minigrasper added approximately 200$ to the case. Discussion. LA with use of two ports and a portless needle grasper is feasible in the majority of cases and was associated with high patient satisfaction and excellent cosmetic results. Avoiding energy devices and staplers is cost saving; the endoloop securely controls appendix and mesoappendix.

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