Glove-Finger Extraction Technique for Laparoscopic Appendectomy: High-Quality Cost-Conscious Surgery

Sharique Nazir, MD¹, Alex Bulanov, MS, DO², Meghedy Shanazarian, BS³, Jordan K Magruder, BS³. ¹NYU Lutheran Medical Center, ²NYIT College of Osteopathic Medicine, ³St. George’s University

Introduction

Compared to an open appendectomy, the procedural costs of a laparoscopic appendectomy (LA) are significantly higher, mainly due to the specialized instrumentation required. Our goal was to investigate the use of an alternative specimen retrieval method device in an LA to assess whether costs can be decreased without compromising the quality of patient care.

Methods

We performed a retrospective chart review of all laparoscopic appendectomies performed by an experienced minimally invasive surgeon at our 500-bed urban community teaching hospital. Outcome parameters were duration of the operation, postoperative complications (intra-abdominal abscesses, wound infections, and post-operative pain), length of hospital stay, and readmission rate.

Technique

The laparoscopic appendectomy was performed in the usual fashion. However, in lieu of a disposable specimen retrieval bag (e.g. EndoCatch™), a glove-finger approach was used. The middle finger of a size 8.5 brown glove is cut off at an oblique angle and inserted via the 12mm umbilical port using a Davis and Geck grasper under the direct visualization of a 5 mm camera. The finger is then held by its upper edge and the appendix is slid completely in. The glove finger is then withdrawn through the 12mm umbilical port.

Results

Between 2012 and 2015, 128 laparoscopic appendectomies were performed, 49 of which utilized the glove finger extraction technique. The OR time for the glove-finger technique was 48 minutes, significantly shorter than the EndoCatch time of 58 minutes (p = 0.009). There were no significant differences in length of stay (p = 0.58). One glove-finger patient had a post-operative fever and one had some abdominal pain:  both were successfully treated with acetaminophen, for a complication rate of about 4%. The EndoCatch™ group had 6 complications of varying severity for a complication rate of 8%.

Conclusion

The greatest disadvantage of the laparoscopic procedure is its significantly higher equipment cost compared to the open approach. Although our data suggest comparable outcomes for both techniques, this may be limited by our small sample size and selection biases as to when to use the glove-finger. We propose that the glove-finger extraction technique allows us to maintain an optimal standard of patient care while reducing the financial burden of the LA by decreasing the use of disposable specimen bags (EndoCatch™ cost: $69). Future studies with larger sample sizes are needed to confirm our findings.