{"title":"Development of a Two Port Laparoscopic Appendectomy Technique at a Rural Hospital.","authors":"Hugo J R Bonatti","doi":"10.1155/2019/9761968","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Laparoscopic appendectomy (LA) is most commonly performed using two 5-mm and one 10/12-mm ports. Various attempts to reduce the number and size of ports have been made and new technologies such as single port LA have been introduced. Appendix and mesoappendix are usually divided with a stapler or energy device with electrocautery, clips, and endoloop being cheaper options.</p><p><strong>Patients and methods: </strong>This study includes 51 consecutive LAs performed at a rural hospital. Patients were divided into 4 groups: group 1 was the standard technique group (n=12), group 2 served as a \"try-out\" (n=12), group 3 served as feasibility group (n=12), and group 4 was the final patient cohort in which the optimized technique was preferably used (n=15).</p><p><strong>Results: </strong>Median age of the study cohort was 35.4 (range: 6.2-80.6) years, and 55% of patients were male. Whereas in G1 all patients had standard port placement (10/12-mm, 2x5-mm), in an increasing number of patients in G2-4 only two 5-mm ports and the 2.3-mm Teleflex minigrasper were inserted. Usage of staplers and/or energy devices was reduced from 100% in G1 to 20% in G4, and in the majority of cases both the appendix and the vascular pedicle were secured with an endoloop. The new technique did not add time to the procedure or total OR time. No stump-leaks or surgical site infections were encountered in this series, and there were no conversions to open surgery. Cost savings when not using a stapler or energy device are approximately 400$ per case; the minigrasper added approximately 200$ to the case.</p><p><strong>Discussion: </strong>LA with use of two ports and a portless needle grasper is feasible in the majority of cases and was associated with high patient satisfaction and excellent cosmetic results. Avoiding energy devices and staplers is cost saving; the endoloop securely controls appendix and mesoappendix.</p>","PeriodicalId":45110,"journal":{"name":"Minimally Invasive Surgery","volume":null,"pages":null},"PeriodicalIF":1.3000,"publicationDate":"2019-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2019/9761968","citationCount":"3","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Minimally Invasive Surgery","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1155/2019/9761968","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2019/1/1 0:00:00","PubModel":"eCollection","JCR":"Q3","JCRName":"SURGERY","Score":null,"Total":0}
引用次数: 3
Abstract
Background: Laparoscopic appendectomy (LA) is most commonly performed using two 5-mm and one 10/12-mm ports. Various attempts to reduce the number and size of ports have been made and new technologies such as single port LA have been introduced. Appendix and mesoappendix are usually divided with a stapler or energy device with electrocautery, clips, and endoloop being cheaper options.
Patients and methods: This study includes 51 consecutive LAs performed at a rural hospital. Patients were divided into 4 groups: group 1 was the standard technique group (n=12), group 2 served as a "try-out" (n=12), group 3 served as feasibility group (n=12), and group 4 was the final patient cohort in which the optimized technique was preferably used (n=15).
Results: Median age of the study cohort was 35.4 (range: 6.2-80.6) years, and 55% of patients were male. Whereas in G1 all patients had standard port placement (10/12-mm, 2x5-mm), in an increasing number of patients in G2-4 only two 5-mm ports and the 2.3-mm Teleflex minigrasper were inserted. Usage of staplers and/or energy devices was reduced from 100% in G1 to 20% in G4, and in the majority of cases both the appendix and the vascular pedicle were secured with an endoloop. The new technique did not add time to the procedure or total OR time. No stump-leaks or surgical site infections were encountered in this series, and there were no conversions to open surgery. Cost savings when not using a stapler or energy device are approximately 400$ per case; the minigrasper added approximately 200$ to the case.
Discussion: LA with use of two ports and a portless needle grasper is feasible in the majority of cases and was associated with high patient satisfaction and excellent cosmetic results. Avoiding energy devices and staplers is cost saving; the endoloop securely controls appendix and mesoappendix.
背景:腹腔镜阑尾切除术(LA)最常使用两个5毫米和一个10/12毫米端口进行。为了减少港口的数量和大小,人们进行了各种尝试,并引入了诸如单港口LA等新技术。阑尾和阑尾中系膜通常用吻合器或电切、夹和内环等能量装置进行分割,这是较便宜的选择。患者和方法:本研究包括在一家农村医院进行的51例连续联合手术。将患者分为4组:第1组为标准技术组(n=12),第2组为“试用”组(n=12),第3组为可行性组(n=12),第4组为优选优化技术的最终患者队列(n=15)。结果:研究队列的中位年龄为35.4岁(范围:6.2-80.6),55%的患者为男性。G1期所有患者均采用标准端口置入(10/ 12mm, 2x5mm),而在G2-4期越来越多的患者中,仅置入两个5mm端口和2.3 mm Teleflex迷你钳。吻合器和/或能量装置的使用从G1的100%减少到G4的20%,并且在大多数情况下阑尾和血管蒂都用内环固定。新技术不会增加手术时间或总手术时间。本病例中没有残肢泄漏或手术部位感染,也没有转开手术。当不使用订书机或能源设备时,每箱节省的成本约为400美元;这个小窃贼给这个案子加了大约200美元。讨论:在大多数情况下,使用双端口和无端口抓针器的LA是可行的,并且与高患者满意度和良好的美容效果相关。避免能源装置和订书机,节约成本;内环安全控制阑尾和阑尾中膜。