Mini Two-port Laparoscopic Appendicectomy with Novel Knotting Technique

Background: In pursuit of minimizing surgical trauma and achieving better esthetics by reducing the size and number of ports, this mini two-port technique was devised to offer an easier and safe alternative in comparison to conventional three-port technique. An easy and cost-effective mini two-port appendicectomy is made possible with a unique intracorporeal surgical knotting through a single 5-mm port with a single instrument, thus reducing number and size of ports and with a better cosmetic result. Materials and methods: Total 200 patients underwent laparoscopic appendicectomy out of which, mini two-port appendicectomy (TPA) with novel knotting technique could be successfully performed on 168 patients (84%) and remaining 32 patients (16%) required conventional three-port technique (CLA). None of the cases were converted to open. Results: Patient undergoing two-port laparoscopic appendicectomy had shorter operative time with better cosmetic result with no incidence of port-site hernia. There was no difficulty in adhesiolysis and intraoperative bleeding control. Infection rate was 0.59% and 3.12% for TPA and CLA, respectively. Incidence of intraoperative bleeding and intraoperative rupture of appendix was less in TPA (1.19% and 0%) as compared to CLA (6.25% and 3.125%). Mean hospital stay was less in TPA (1.7 days) compared to CLA (2.1 days). Conclusion: This mini two-port technique with novel knotting technique is easy to learn and helps to overcome the challenges and limitations faced during two laparoscopic appendicectomies; however conversion to conventional approach in complicated cases is still advisable. It is safe and effective intermediate option from conventional three-port to SILS/NOTES/Endo GIA staplers.