David Coyle, MD, MB, BCh, BAO, MRCSI, Kate B Savoie, MD, Karen A Diefenbach, MD. Nationwide Children’s Hospital
Objective of the Device: Appendectomy is the most common surgical emergency. In order to mitigate high operating room charges associated with longer surgeries, many surgeons use endoscopic staplers to divide the appendix base and, sometimes, the mesoappendix. Traditionally this requires a larger 10mm port to accommodate the endoscopic stapler, increasing the risk of port-site complications, such as hernia, and post-operative pain, which impedes same-day discharge in otherwise eligible patients. The JustRight™ 5mm endoscopic stapler is designed for the small working space encountered in pediatric minimally invasive surgery. In this case series, the JustRight™ 5mm stapler in was used to limit port size in patients undergoing emergency laparoscopic appendectomy.
Description of the Technology/Method of its Use: The JustRight™ 5mm stapler has a 20cm long, 5mm diameter shaft, which fits through any 5mm port-site. When deployed it leaves 2 rows of 2mm B-shaped staples with a staple length of 2.5cm. The stapler allows for 360 degrees of jaw rotation. We reviewed the medical records of all patients at our institution with a diagnosis of acute appendicitis, in whom the JustRight™ 5mm stapler was used to perform appendectomy, with particular reference to patient demographics, staple line complications, and standard outcomes after surgery such as post-operative hospital stay.
Preliminary Results: Twenty-five patients underwent laparoscopic appendectomy using the JustRight™ 5mm stapler over a 6 month period. Seventeen were male (68%). The median age at surgery was 10.6 years (3.3 – 16.9 years). The median duration of symptoms at presentation was 1 day (1-4 days). The median weight was 38.3kg (12.3kg – 76.9kg) and median BMI was 17.8 kg/m2 (13 – 24.3 kg/m2).
On imaging, the median appendix diameter was 8.6mm (7-11mm) with an appendicolith identified in 11 cases (44%). The pre-operative diagnosis was guided by imaging with ultrasound alone in 22 cases (88%), CT alone in 2 (8%) and both together in 1 (4%). Pre-operative imaging suggested a concern for perforation in 6 patients (24%).
Perforated appendicitis was the operative diagnosis in 3 patients (12%). The appendix was amputated using the JustRight™ 5mm stapler in all patients. Persistent bleeding from the stump staple line required application of a hemostatic clip in one patient. The JustRight™ 5mm stapler was used to additionally divide the mesoappendix in 3 patients (12%) without complication. There were no staple misfires and no recorded cases of staple-line leak in this series. The median operating time was 35 minutes (21-52 minutes). Same day discharge after appendectomy was achieved in 17 patients (68%). Six additional patients went home on the first post-operative day and 2 patients with perforated appendicitis had an inpatient stay of 5 days. There was one re-admission with a pelvic abscess in a patient who had been managed as uncomplicated appendicitis.
Conclusions: The JustRight™ 5mm stapler can be employed safely for laparoscopic appendectomy in patients regardless of age or size, with potentially beneficial effects on post-operative analgesia requirements and hospital stay, and avoiding the need for 10mm port-sites. Successful use is determined by the size of the appendix base.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 98866
Program Number: ETP758
Presentation Session: Emerging Technology Poster Session (Non CME)
Presentation Type: Poster