Single Incision Laparoscopic Appendectomy Using Conventional Non-Articulate Instruments: Is This the Future to Remove an Appendix?

Swee H Teh, MD, David McAllister. Department of Minimally Invasive Surgery, Sacred Heart Medical Center

Introduction:
Single incision laparoscopic surgery could potentially be more widely applicable compared to natural orifice transluminal endoscopic surgery (NOTES) for appendectomy. The aim of this prospective study is to see whether single incision laparoscopic appendectomy (SILA) can be performed safely using conventional, non-articulate instruments and still be cost-effective.

Methods.
Prospective analysis of all patients undergoing SILA between Dec 2008 and Aug 2010 was conducted. All SILA was performed via an infraumbillical incision followed by insertion of one 10 mm trocar and two 5 mm trocars on each side.

Results.
There were one hundred and five patients (67 M / 38 F) with the mean age of 32 years old (range 6-67) and a mean BMI of 28 (range 15-39) in this prospective study cohort. One hundred and two patients were admitted through the emergency room and had non-elective SILA and 3 other patients had elective SILA. Intraoperative findings were acute appendicitis in 42, acute suppurative appendicitis in 47, perforated appendicitis in 11 and gangrenous appendicitis in 5 patients. 13 patients (12.7%) had partial cecectomy. The mean operative time was 21.7 minutes (range 12-60). One hundred and three patients (99%) had successful SILA without additional need for trocars/incision or conversion to open surgery. Two patients required additional 5 mm trocar to be inserted for mobilization of a perforated appendicitis. These two patients also had surgical drains inserted. The mean hospital stay was less than 1 day (range 0-2). 82 patients (78%) were dismissed home the same day. Perioperative morbidity included five patients (4.7 %) with urinary retention and three patients (2.8%) with superficial wound infections. There was no perioperative mortality. After a mean follow up of 7.8 months, there was no report of incisional hernia.

Conclusion.
Current described technique of single incision laparoscopic appendectomy is safe and feasible across both adult and pediatric age group. This approach is also cost effective as it allows avoiding the use of specialized port/trocar or articulate laparoscopic instruments designed for single incision laparoscopic surgery.


Session: Poster
Program Number: P171
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