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      Application of Single Incision Laparoscopic Surgery for Appendectomies in Patients with Complicated Appendicitis

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          Abstract

          Purpose

          Recently, single incision laparoscopic surgery (SILS) has been studied for its being less invasive surgery and having cosmetic improvement. We investigated the application of SILS for an appendectomy (SILS-A) in cases of complicated appendicitis and compare it with a conventional laparoscopic appendectomy (C-LA).

          Methods

          This study involved a total of 40 patients who underwent C-LA or SILS-A in patients with complicated appendicitis; 25 patients received a C-LA, and the other 15 patients received a SILS-A. The clinical outcomes and cosmetic results were compared between the groups.

          Results

          The SILS-A procedures were performed successfully in patients with complicated appendicitis, but 6 patients who underwent SILS-A needed an additional port for dissection and drainage. Clinical outcomes and postoperative complications were similar in both study groups. The SILS-A group showed significantly higher numbers of pain control than the C-LA group, and the one port SLLS-A group showed significantly better cosmetic result than the C-LA group.

          Conclusion

          SILS-A is technically feasible and safe in patients with complicated appendicitis. However, SILS-A has more postoperative pain than C-LA, and more active pain control should be considered for patients undergoing SILS-A.

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          Most cited references17

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          Endoscopic appendectomy.

          K. Semm (1983)
          These newly developed endoscopic methods in gynaecology for haemostasis during surgical pelviscopy (Endocoagulation Roeder-loop ligation, endoligature, endo-suture with intra- and extracorporeal knotting) make it possible to carry out appendectomy by endoscopy for any of the following indications: Postoperative adhesion of the appendix especially in "sterility" patients, elongated appendix extending into the small pelvis, endometriosis of the appendix, subacute and chronic appendicitis. The instrument-set employed in this method permits the performance of all the usual classical operative steps (purse-string suture, and Z-suture acc. to McBurney and Sprengel). The point for resection has to be sterilized over 20-30 sec. at 212 degrees F using the crocodile forceps (endocoagulation procedure) before division and extraction of the appendix is effected.
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            Single port access laparoscopic right hemicolectomy.

            Francois Pugin, Philippe Morel, Pascal Bucher (2008)
            Single port access (SPA) surgery is a rapidly evolving field as it combines some of the cosmetic advantage of the Natural Orifice Translumenal Endoscopic Surgery (NOTES) and allows performing surgical procedure with standard surgical instruments. We report in this paper a new technique of umbilical SPA right hemicolectomy with conventional surgical oncologic principle and technique of minimally invasive colectomy. Preliminary experience with umbilical SPA right hemicolectomy in a patient with degenerated ascending colon polyp. Umbilical SPA right hemicolectomy was feasible with conventional laparoscopic instruments. Carcinologic surgical principle can be respected using this technique as pathological specimen had sufficient surgical margins (>10 cm) and lymph nodes (33). Operative time was 158 min. No peroperative or postoperative complications were recorded. SPA right hemicolectomy is feasible and safe when performed by experienced laparoscopic surgeons. SPA right hemicolectomy may have the advantage over NOTES approach to offer the safety of laparoscopic colectomy especially for haemostasis and anastomosis. It has to be determined whether or not this approach would offer benefit to patients, except in cosmesis, compared to standard laparoscopic right hemicolectomy.
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              Single-port urological surgery: single-center experience with the first 100 cases.

              Wesley White, Georges-Pascal Haber, Raj Goel … (2009)
              To present perioperative outcomes in an observational cohort of patients who underwent LaparoEndoscopic Single Site (LESS) surgery at a single academic center. A prospective study was performed to evaluate patient outcomes after LESS urologic surgery. Demographic data including age, body mass index, operative time, estimated blood loss, operative indications, complications, and postoperative Visual Analog Pain Scale scores were accrued. Patients were followed postoperatively for evidence of adverse events. Between September 2007 and February 2009, 100 patients underwent LESS urologic surgery. Specifically, 74 patients underwent LESS renal surgery (cryoablation, 8; partial nephrectomy, 15; metastectomy, 1; renal biopsy, 1; simple nephrectomy, 7; radical nephrectomy, 6; cyst decortication, 2; nephroureterectomy, 7; donor nephrectomy, 19; and dismembered pyeloplasty, 8) and 26 patients underwent LESS pelvic surgery (varicocelectomy, 3; radical prostatectomy, 6; radical cystectomy, 3; sacral colpopexy, 13; and ureteral reimplant, 1). Mean patient age was 54 years. Mean body mass index was 26.2 kg/m(2). Mean operative time was 199 minutes. Mean estimated blood loss was 136 mL. No intraoperative complications occurred. Six patients required conversion to standard laparoscopy. Mean length of hospitalization was 3 days. Mean Visual Analog Pain Scale score at discharge was 1.5/10. At a mean follow-up of 11 months, 9 Clavien Grade II (transfusion, 7; urinary tract infection, 1; deep vein thrombosis, 1) and 2 Clavien Grade IIIb (recto-urethral fistula, 1; angioembolization, 1) surgical complications occurred. In our experience, LESS urologic surgery is feasible, offers improved cosmesis, and may offer decreased pain. Complications are consistent with the published data. Whether LESS urologic surgery is superior in comparison with standard laparoscopy is currently speculative.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Korean Soc Coloproctology
                Journal ID (publisher-id): JKSC
                Title: Journal of the Korean Society of Coloproctology
                Publisher: The Korean Society of Coloproctology
                ISSN (Print): 2093-7822
                ISSN (Electronic): 2093-7830
                Publication date (Print): December 2010
                Publication date (Electronic): 31 December 2010
                Volume: 26
                Issue: 6
                Pages: 388-394
                Affiliations
                Department of Surgery, Digestive Disease Research Institute and Institute of Medical Science, Wonkwang University College of Medicine, Iksan, Korea.
                [1 ]Department of Anesthesiology, Digestive Disease Research Institute and Institute of Medical Science, Wonkwang University College of Medicine, Iksan, Korea.
                Author notes
                Correspondence to: Jeong Kyun Lee, M.D. Department of Surgery and Institute of Medical Science, Wonkwang University College of Medicine, 344-2 Sinyoung-dong, Iksan 570-711, Korea. Tel: +82-63-859-1492, Fax: +82-63-855-2386, rjk@ 123456wonkwang.ac.kr
                Article
                DOI: 10.3393/jksc.2010.26.6.388
                PMC ID: 3017973
                PubMed ID: 21221238
                SO-VID: aac1362f-5d10-4786-b5b7-bae9f00a7399
                Copyright © © 2010 The Korean Society of Coloproctology
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 12 August 2010
                Date accepted : 06 October 2010
                Categories
                Subject: Original Article

                ScienceOpen disciplines: Gastroenterology & Hepatology
                Keywords: appendicitis,laparoscopy,single incision
                Data availability:
                ScienceOpen disciplines: Gastroenterology & Hepatology
                Keywords: appendicitis, laparoscopy, single incision

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