Study of single port laparoscopic appendectomy

Kazuhiro Takehara, MD, Jun Aoki, MD, Yuu Okazawa, MD, Rina Takahashi, MD, Kosuke Mizukoshi, MD, Masaya Kawai, MD, Yoshihiko Tashiro, MD, Shinya Munakata, MD, Shyun Ishiyama, MD, Kiichi Sugimoto, MD, Makoto Takahashi, MD, Yukihiro Yaginuma, MD, Yutaka Kojima, MD, Michitoshi Gotou, MD, Atsushi Okuzawa, MD, Yuuichi Tomiki, MD, Kazuhiro Sakamoto, MD

Department of coloproctological surgery, Juntendo University Faculty of Medicine, Tokyo, Japan

a. Objective of the study
Recently, single-port laparoscopic surgery (SPLS) has been performed as a procedure of laparoscopic surgery due to its merits regarding postoperative wound pain and cosmetic features. In our department, laparoscopic appendectomy (LA) was introduced to treat appendicitis in August 2007. Single port laparoscopic appendectomy (SPLA) was applied from July 2010. Currently, this procedure is indicated for mild-status patients, those with localized peritonitis, and those in whom interval appendectomy (IA) was selected.

b. Methods and procedures
Surgery for appendicitis was performed in 143 patients between January 2007 and September 2012. Twenty-nine patients underwent LA. Of these, we investigated 21 who underwent SPLA.

c. Results
The subjects consisted of 10 males and 11 females, with a mean age of 41 years (17 to 76 years). The mean operation time was 114 minutes (57 to 232 minutes). The mean postoperative admission period was 6 days (2 to 12 days). As platforms, an SILS port™ was used in 4 patients, and an EZ access™ in 17. In all patients, forceps were manipulated using the parallel method. For appendicular root treatment, an Endo GIA™ Universal Stapler was used in 11 patients, treatment was conducted under direct vision in 9, and an endo-loop device was used in 1. In 5 patients, elective IA was performed. Of these, a 5-mm port was added (suprapubic area) in 2, and a drain was inserted in 3. Histopathological findings suggested catarrhal appendicitis in 5 patients, suppurative appendicitis in 10, and gangrenous appendicitis in 6. As a postoperative complication, epidural catheter insertion-related cerebrospinal fluid hypovolemia was observed in 1 patient. However, there were no complications related to surgery for appendicitis. Concerning cosmetic features, there was no marked deformity of a postoperative wound in the navel region or late pain in any patient.

d. Conclusions based on the results
The procedure of SPLA is being established in our department. However, various limitations such as difficulty in visual-field development and the safety of surgical operations should be reviewed in the future. In particular, whether SPLA can be increasingly indicated for patients with severe appendicitis or other diseases, as well as surgeons’ learning curves, cosmetic features, and costs, should be examined in a larger number of patients.

Session: Poster Presentation

Program Number: P514

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