Reduced port surgery for appendectomy:Early experience and surgical technique

作     者：Shinichiro Mori Kenji Baba Shigehiro Yanagita Yoshiaki Kita Kosei Maemura Yuko Mataki Yasuto Uchikado Hiroshi Okumura Tetsuhiro Nakajyo Shoji Natsugoe Sonshin Takao Kuniaki Aridome 

作者机构：Department of Digestive Surgery Breast and Thyroid Surgery Graduate School of Medicine Kagoshima University Kagoshima 890-8520 Japan Frontier Science Research Center Kagoshima University Kagoshima 890-8520 Japan Department of Surgery Nanpuh Hospital NKagoshima 892-8512 Japan 

出 版 物：《World Journal of Surgical Procedures》 (世界外科手术杂志)

年 卷 期：2013年第3卷第2期

页      面：8-12页

学科分类：10[医学] 

主　　题：Reduced port surgery Appendectomy Laparoscopy Cosmesis Single incision 

摘      要：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 mmH g 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.