Two-port laparoscopic appendectomy assisted with needle grasper comparison with conventional laparoscopic appendectomy

Abstract

Purpose: The 2-port laparoscopic appendectomy technique (TLA) is between the conventional 3-port and single-port laparoscopic appendectomy surgeries. We compared postoperative pain and cosmetic results after TLA with conventional laparoscopic appendectomy (CLA) by a 3-port device.

Methods: Patients undergoing TLA were matched with patients undergoing CLA between February 2015 and November 2015 at the same institution. Thirty-two patients underwent TLA with a needle grasper. The appendix was secured by a percutaneous organ-holding device (needle grasper), then removed through a puncture at McBurney's point. Another 38 patients underwent CLA. Patient demographics, operative details, and postoperative outcomes were collected and evaluated.

Results: One patient in the TLA group developed a wound infection and 1 patient in the CLA group developed a postoperative intra-abdominal abscess and 3 wound infections. There was no significant difference between the groups when comparing the length of hospital stay, time until oral intake, and other complications. The pain score in the first 12 hours after surgery was significanly higher in CLA group than the TLA group (P < 0.001). Operative time was significantly shorter in the CLA group compared to the TLA group (P < 0.001).

Conclusion: TLA using a needle grasper was associated with a significantly lower pain score 12 hours after surgery, better cosmetic results, and lower cost, than the CLA 3-port procedure because of the fewer number of ports.

Keywords: Appendectomy; Laparoscopic surgery; Minimal invasive surgical procedures.

Fig. 1. (A) Needle Grasper device (Percutaneous Organ Holder Device, Suture Grasper Closure Device, Mediflex Surgical Products, Islandia, NY, USA). (B) Position of the needle grasper at operation. (C) Immediate image of the abdomen. (D) Postoperative 20th day image of the abdomen.

Fig. 2. (A) Holding and tracting of appendix by needle grasper (a; Percutaneous Organ Holder Device, Suture Grasper Closure Device, Mediflex Surgical Products, Islandia, NY, USA). (B) Needle grasper (a), Endoloop (b).