Ann Surg Treat Res.  2016 Aug;91(2):59-65. 10.4174/astr.2016.91.2.59.

Two-port laparoscopic appendectomy assisted with needle grasper comparison with conventional laparoscopic appendectomy

• Donmez T
• Hut A
• Avaroglu H
• Uzman S
• Yildirim D
• Ferahman S
• Cekic E

• KMID: 2344496
• DOI: http://doi.org/10.4174/astr.2016.91.2.59

Abstract

PURPOSE
The 2-port laparoscopic appendectomy technique (TLA) is between the conventional 3-port and single-port laparoscopic appendectomy surgeries. We compared postoperative pain and cosmetic results after TLA with conventional laparoscopic appendectomy (CLA) by a 3-port device.
METHODS
Patients undergoing TLA were matched with patients undergoing CLA between February 2015 and November 2015 at the same institution. Thirty-two patients underwent TLA with a needle grasper. The appendix was secured by a percutaneous organ-holding device (needle grasper), then removed through a puncture at McBurney's point. Another 38 patients underwent CLA. Patient demographics, operative details, and postoperative outcomes were collected and evaluated.
RESULTS
One patient in the TLA group developed a wound infection and 1 patient in the CLA group developed a postoperative intra-abdominal abscess and 3 wound infections. There was no significant difference between the groups when comparing the length of hospital stay, time until oral intake, and other complications. The pain score in the first 12 hours after surgery was significanly higher in CLA group than the TLA group (P < 0.001). Operative time was significantly shorter in the CLA group compared to the TLA group (P < 0.001).
CONCLUSION
TLA using a needle grasper was associated with a significantly lower pain score 12 hours after surgery, better cosmetic results, and lower cost, than the CLA 3-port procedure because of the fewer number of ports.

Keyword

Laparoscopic surgery; Appendectomy; Minimal invasive surgical procedures

MeSH Terms

Abdominal Abscess
Appendectomy*
Appendix
Demography
Humans
Laparoscopy
Length of Stay
Needles*
Operative Time
Pain, Postoperative
Punctures
Wound Infection

Figure

• 

  Fig. 1 (A) Needle Grasper device (Percutaneous Organ Holder Device, Suture Grasper Closure Device, Mediflex Surgical Products, Islandia, NY, USA). (B) Position of the needle grasper at operation. (C) Immediate image of the abdomen. (D) Postoperative 20th day image of the abdomen.

• 

  Fig. 2 (A) Holding and tracting of appendix by needle grasper (a; Percutaneous Organ Holder Device, Suture Grasper Closure Device, Mediflex Surgical Products, Islandia, NY, USA). (B) Needle grasper (a), Endoloop (b).

Reference

1. Tiwari MM, Reynoso JF, Tsang AW, Oleynikov D. Comparison of outcomes of laparoscopic and open appendectomy in management of uncomplicated and complicated appendicitis. Ann Surg. 2011; 254:927–932.

2. Wei HB, Huang JL, Zheng ZH, Wei B, Zheng F, Qiu WS, et al. Laparoscopic versus open appendectomy: a prospective randomized comparison. Surg Endosc. 2010; 24:266–269.

3. Lee J, Baek J, Kim W. Laparoscopic transumbilical single-port appendectomy: initial experience and comparison with three-port appendectomy. Surg Laparosc Endosc Percutan Tech. 2010; 20:100–103.

4. Lee YS, Kim JH, Moon EJ, Kim JJ, Lee KH, Oh SJ, et al. Comparative study on surgical outcomes and operative costs of transumbilical single-port laparoscopic appendectomy versus conventional laparoscopic appendectomy in adult patients. Surg Laparosc Endosc Percutan Tech. 2009; 19:493–496.

5. St Peter SD, Adibe OO, Juang D, Sharp SW, Garey CL, Laituri CA, et al. Single incision versus standard 3-port laparoscopic appendectomy: a prospective randomized trial. Ann Surg. 2011; 254:586–590.

6. Park JH, Hyun KH, Park CH, Choi SY, Choi WH, Kim DJ, et al. Laparoscopic vs transumbilical single-port laparoscopic appendectomy; results of prospective randomized trial. J Korean Surg Soc. 2010; 78:213–218.

7. Olijnyk JG, Pretto GG, da Costa Filho OP, Machado FK, Silva Chalub SR, Cavazzola LT. Two-port laparoscopic appendectomy as transition to laparoendoscopic single site surgery. J Minim Access Surg. 2014; 10:23–26.

8. Golebiewski A, Losin M, Murawski M, Wiejek A, Lubacka D, Czauderna P. One, two or three port appendectomy: a rational approach. Wideochir Inne Tech Maloinwazyjne. 2013; 8:226–231.

9. Wei B, Qi CL, Chen TF, Zheng ZH, Huang JL, Hu BG, et al. Laparoscopic versus open appendectomy for acute appendicitis: a metaanalysis. Surg Endosc. 2011; 25:1199–1208.

10. Bernhardt J, Steffen H, Schneider-Koriath S, Ludwig K. Clinical NOTES appendectomy study: comparison of transvaginal NOTES appendectomy in hybrid technique with laparoscopic appendectomy. Int J Colorectal Dis. 2015; 30:259–267.

11. Kim HO, Yoo CH, Lee SR, Son BH, Park YL, Shin JH, et al. Pain after laparoscopic appendectomy: a comparison of transumbilical single-port and conventional laparoscopic surgery. J Korean Surg Soc. 2012; 82:172–178.

12. Lee CH, Jeon WJ, Youn SJ, Yun HY, Jang LC, Choi JW, et al. The experience of transumbilical endoscopic appendectomies. Ann Surg Treat Res. 2014; 86:278–282.

13. Carter JT, Kaplan JA, Nguyen JN, Lin MY, Rogers SJ, Harris HW. A prospective, randomized controlled trial of single-incision laparoscopic vs conventional 3-port laparoscopic appendectomy for treatment of acute appendicitis. J Am Coll Surg. 2014; 218:950–959.

14. Mayer S, Werner A, Wachowiak R, Buehligen U, Boehm R, Geyer C, et al. Single-incision multiport laparoscopy does not cause more pain than conventional laparoscopy: a prospective evaluation in children undergoing appendectomy. J Laparoendosc Adv Surg Tech A. 2011; 21:753–756.

15. Gulpinar K, Ozdemir S, Ozis SE, Aydin T, Korkmaz A. Single incision laparoscopic cholecystectomy by using a 2 mm atraumatic grasper without trocar. HPB Surg. 2011; 2011:761315.

16. Sajid MS, Khan MA, Cheek E, Baig MK. Needlescopic versus laparoscopic appendectomy: a systematic review. Can J Surg. 2009; 52:129–134.

17. Roberts KE. True single-port appendectomy: first experience with the "puppeteer technique". Surg Endosc. 2009; 23:1825–1830.

18. Yeung GH. The intravenous catheter at McBurney's point. Surg Laparosc Endosc. 1999; 9:45–48.

19. Ates O, Hakguder G, Olguner M, Akgur FM. Single-port laparoscopic appendectomy conducted intracorporeally with the aid of a transabdominal sling suture. J Pediatr Surg. 2007; 42:1071–1074.

20. Panait L, Bell RL, Duffy AJ, Roberts KE. Two-port laparoscopic appendectomy: minimizing the minimally invasive approach. J Surg Res. 2009; 153:167–171.

21. Vidal O, Ginesta C, Valentini M, Marti J, Benarroch G, Garcia-Valdecasas JC. Suprapubic single-incision laparoscopic appendectomy: a nonvisible-scar surgical option. Surg Endosc. 2011; 25:1019–1023.