Brief Article
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World J Surg Proced. Jul 28, 2013; 3(2): 8-12
Published online Jul 28, 2013. doi: 10.5412/wjsp.v3.i2.8
Reduced port surgery for appendectomy: Early experience and surgical technique
Shinichiro Mori, Kenji Baba, Shigehiro Yanagita, Yoshiaki Kita, Kosei Maemura, Yuko Mataki, Yasuto Uchikado, Hiroshi Okumura, Akihiro Nakajyo, Shoji Natsugoe, Sonshin Takao, Kuniaki Aridome
Shinichiro Mori, Kenji Baba, Shigehiro Yanagita, Yoshiaki Kita, Kosei Maemura, Yuko Mataki, Yasuto Uchikado, Hiroshi Okumura, Shoji Natsugoe, Tetsuhiro Nakajyo, Department of Digestive Surgery, Breast and Thyroid Surgery, Graduate School of Medicine, Kagoshima University, Kagoshima 890-8520, Japan
Sonshin Takao, Frontier Science Research Center, Kagoshima University, Kagoshima 890-8520, Japan
Kuniaki Aridome, Department of Surgery, Nanpuh Hospital, NKagoshima 892-8512, Japan
Author contributions: Mori S and Baba K contributed equally to this work; Mori S, Baba K, Yanagita S, Kita Y, Maemura K, Mataki Y, Uchikado Y, Okumura H, Nakajyo T, Takao S, Aridome K and Natsugoe S designed the study; Mori S and Baba K analyzed the data; Mori S, Takao S and Natsugoe S wrote the paper.
Correspondence to: Shinichiro Mori, MD, PhD, Department of Digestive Surgery, Breast and Thyroid Surgery, Graduate School of Medicine, Kagoshima University, Sakuragaoka 8-35-1, Kagoshima 890-8520, Japan. morishin@m3.kufm.kagoshima-u.ac.jp
Telephone: +81-992-755361 Fax: +81-992-657426
Received: February 4, 2013
Revised: April 25, 2013
Accepted: June 5, 2013
Published online: July 28, 2013
Abstract

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.

Keywords: Reduced port surgery, Appendectomy, Laparoscopy, Cosmesis, Single incision

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.