Ligation of the Appendix with Polymetric Clips

Lawrence E Tabone, MD, Dana Portenier, MD, Chan W Park, MD. Duke University.

1. Objective of the technology or device

Laparoscopic appendectomy has increased operative cost as compared to open appendectomy.  A significant component of operative cost associated with laparoscopic appendectomy is advanced energy systems and endoscopic staplers.  Our objective was to study a new application of existing technology to provide safe, easy, cost effective ligation of the appendix and appendiceal artery. 

2. Description of the technology and method of its use or application

Commercially available polymetric clips have been successfully used for the ligation of vessels as well as the cystic duct in cholecystectomy.  Polymetric clips and their delivery systems have a substantially lower cost associated with them as compared to advanced energy devices and endoscopic staplers.  The size of structures able to be ligated by polymetric clips has recently increased because of advances in technology.  Additionally, animal studies have shown less tissue inflammation associated with polymetric clips as associated with suture material.  To study a new application for polymetric clips we have prospectively enrolled subjects into a trial using polymetric clips for ligation of the appendix and appendiceal artery during laparoscopic appendectomy. 

3. Preliminary results if available

We have prospectively enrolled 11 patients with acute appendicitis into an IRB approved study using polymetric clips for ligation of the appendix during laparoscopic appendectomy.  The average length of stay after laparoscopic appendectomy with polymetric clips is 1.4 days which is unchanged from our previous length of stay using endoscopic staplers.  We have reported no complications associated with using polymetric clips for appendiceal ligation with a 30 day follow-up in 11 subjects.  All enrolled subjects had successful completion of appendectomy without the use of endoscopic staplers which reduced material operative cost by 600 dollars.

4. Conclusions / future directions.

Increased subject enrolment and continued follow-up is needed to confirm the safe and cost effective benefits of polymetric clips for the ligation of the appendix.  As the preliminary data suggests, a significant reduction in operative material expense for laparoscopic appendectomy can be achieved by using polymetric clips while maintaining the same patient outcomes.

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