Surgical Treatment Outcomes of Trans-umbilical Single Port Access Laparoscopic Appendectomy By Using Mini-laparoscopic Instruments for Complicated Acute Gangrenous Appendicitis

Yoshiyuki Kawakami, PhD, Hidenori Fujii, PhD, Riki Ganeko, MD, Kei Hirose, MD, Makoto Yoshida, PhD, Koji Doi, PhD, Tshiharu Aotake, PhD, Yuko Kawamura, MD, Fumie Tanaka, MD, Yuki Hirose, PhD

Department of Surgery, Japanese Red Cross Fukui Hospital, Fukui, Japan

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. It is expected that our technique could be useful for treating these cases.

Methods: From February of 2011 to August of 2012, 28 consecutive patients with acute gangrenous appendicitis were assigned to undergo 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 266 cases of appendectomy for acute appendicitis (From Jun of 2009 to August of 2012) were analyzed retrospectively in background factors, operative time and length of hospital stay. Of them, in 106 cases of acute gangrenous appendicitis (39.8%), 57 cases were treated by laparoscopic surgery with the ratio of laparoscopic surgery to open surgery exceeded up to 57.1% in recent 113 cases, while that was 46.0% in former 153 cases. We had 28 modified TUSPA-LA (male 12, female 16, average age of 41.5, range 7-88) with 9 abscess cases (m 3, f 6, 49.0, 14-75), 10 pure single access (TUSPA-LA) (m 4, f 6, 13.8, 12-15) with 2 (m 2, 17.0), 10 conventional LA (m 6, F 4, 20-82) with 6 (m 5, f 1, 20-66) and 55 open cases (m 27, f 28, 27.7, 4-89) with 18 (m 12, f 6, 64.2, 21-89). The average operative time in the modified group was 86.6 min (40-178) with 122.7 (54-178) in abscess cases, as was 91.9 (42-123) with 120.0 in the pure single access group. The mean hospital stay in the modified group was 5.3 (2-19) days with 8.0 (2-19) in abscess cases, as was 7.1 (2-28) with 6.0 (5-7) in the pure single access 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.

Session: Poster Presentation

Program Number: P508

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