Published online Jul 28, 2013. doi: 10.5412/wjsp.v3.i2.8
Revised: April 25, 2013
Accepted: June 5, 2013
Published online: July 28, 2013
AIM: To evaluate our experience and surgical technique of laparoscopic appendectomy via reduced port surgery (LARPS).
METHODS: Sixteen patients (8 men and 8 women; median age: 31.0 years) who underwent LARPS between November 2009 and May 2012 were included in the present study. We performed LARPS, in which access devices were inserted through an umbilical skin incision with 1 additional skin incision in the left lower abdomen. After setting access devices, pneumoperitoneum was maintained at 10 mmHg using CO2 and a 3 mm trocar was positioned (or direct puncture was performed by the Endo Relief system) under laparoscopic guidance. The mesoappendix was dissected using an ultrasonically activated device. After mesoappendix dissection, ligation was performed near the appendix base and the appendix was dissected using an ultrasonically activated device. The appendix was then removed. At the end of surgery, we administered local anesthesia with ropivacaine 1% (10 mL) for the skin incisions. The outcomes were evaluated in terms of operation time, intraoperative blood loss, length of postoperative hospital stay and surgical complications.
RESULTS: Our surgical procedure allowed operators to use instruments as in conventional laparoscopic appendectomy. The basic principle of triangulation of instrumentation was maintained to some degree. LARPS was performed in 9 patients with catarrhal appendicitis, 5 with phlegmonous appendicitis, and 2 with gangrenous appendicitis. The median surgery time was 60 min and the median intraoperative blood loss was 1.2 mL. The median length of postoperative hospitalization was 4 d. There were no conversions to open surgery, no operation-related complications or mortality.
CONCLUSION: Our experience and surgical technique suggest that LARPS is a safe and feasible procedure for patients with appendicitis.
Core tip: Our experience and surgical technique suggest that laparoscopic appendectomy via reduced port surgery is a safe and feasible procedure for patients with appendicitis. Although the present study showed that this procedure offers cosmetic advantages and technical simplicity, the effectiveness and feasibility of this method should be assessed in randomized trials.