Yoshiyuki Kawakami, PhD, Hidenori Fujii, PhD, Yuki Hirose, PhD. Japanese Red Cross Fukui Hospital
Aims: We previously reported that trans-umbilical single port access laparoscopic appendectomy (TUSPA-LA) for complicated acute gangrenous appendicitis could be feasible with some difficult situation such in cases with intra-abdominal abscess formation. Thus we introduced modified technique for TUSPA-LA consisted in combining conventional 5mm trocar with trans-umbilical single access and newly developed 2-3mm mini-laparoscopic instruments with supra-pubic approach. In this study, we applied this modified technique for appendiceal mucinous neoplasm. It is expected that our technique could be useful for treating these cases.
Methods: From April of 2011 to July of 2015, 4 consecutive patients with appendiceal mucinous neoplasm were assigned to undergo surgical treatment with modified TUSPA-LA at our hospital. We conducted to study our technique using reusable metallic trocar (ENDOTIPTM, 3.3 and 6mm in diameter, KARL STORZ GmbH & Co. KG, Tuttlingen, Germany, BJ-NeedleTM trocar, 2.1mm in diameter, NITI-ON Co., Chiba, Japan) as working port, XCELTM, 5mm in diameter, ETHICON ENDO-SURGERY, INC., Pittsburgh, PA, USA, VERSAPORTTM, 5mm in diameter, COVIDIEN, INC., Mansfield, MA, USA as camera port. Straight-type grasping forceps and dissecting forceps (2.1, 3.3 and 5mm in diameter) were used both in the parallel setup at umbilical site and in the triangular co-axial setup with supra-pubic puncture.
Results: Clinical records of 19 cases of appendiceal neoplasm (From April of 2004 to July of 2015) were analyzed retrospectively in background factors, operative time and length of hospital stay. Of them, 13 cases were treated by laparoscopic surgery. We had 4 modified TUSPA-LA (male 3, female 1, average age of 50.8, range 37-64), 3 pure single cases (m 1, f 2, 44.7, 24-85) and 6 open cases (m 4, f 2, 70.6, 53-78). The average operative time in the modified group was 62.3 min (46-82), as was 91.9 (42-123) in the pure single group, with 94.7 (33-140) in the open group . The median hospital stay in the modified group was 5 (4-5) days, as was 7 (4-7) in the pure single group and 9 (3-32) in the open group. No major postoperative complications were observed.
Conclusions: We conclude that modified technique for TUSPA-LA could be useful for reducing invasiveness while keeping a safety and good cosmetic result as an attractive advantage in managing this condition.