World Journal of Laparoscopic Surgery

Register      Login

VOLUME 13 , ISSUE 1 ( January-April, 2020 ) > List of Articles


Mini Two-port Laparoscopic Appendicectomy with Novel Knotting Technique

Jitendra T Sankpal, Mukund B Tayade, Ajay H Bhandarwar, Priyanka Saha, Soumya Chatnalkar, Sushrut Sankpal, Ameya Gadkari

Keywords : Appendicitis, Laparoscopic appendicectomy, Novel knotting technique, Two-port laparoscopic appendicectomy

Citation Information : Sankpal JT, Tayade MB, Bhandarwar AH, Saha P, Chatnalkar S, Sankpal S, Gadkari A. Mini Two-port Laparoscopic Appendicectomy with Novel Knotting Technique. World J Lap Surg 2020; 13 (1):21-25.

DOI: 10.5005/jp-journals-10033-1398

License: CC BY-NC 4.0

Published Online: 23-07-2020

Copyright Statement:  Copyright © 2020; The Author(s).


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.

  1. Ramdas MJ, Sing QY, Milne D. Association between the appendix and the fecalith in adults. Can J Surg 2015(1):10–14. DOI: 10.1503/cjs.002014.
  2. Lohar HP, Asger Calcuttawala MA, Nirhale DS, et al. Epidemiological aspects of appendicitis in a rural setup. Med J DY Patil Univ 2014;7(6):753–757. DOI: 10.4103/0975-2870.144867.
  3. Patrick DA, Janik JE, Janik JS, et al. Increased CT scan utilization does not improve the diagnostic accuracy of appendicitis in children. J Pediatr Surg 2003;38(5):659–662. DOI: 10.1016/jpsu.2003.5017.
  4. Buckius MT, McGrath B, Monk J, et al. Changing epidemiology of acute appendicitis in the United States: study period 1993-2008. J Surg Res 2012;175(2):185–190. DOI: 10.1016/j.jss.2011.07.017.
  5. Douglas CD, Macpherson NE, Davidson PM, et al. Randomised controlled trial of ultrasonography in diagnosis of acute appendicitis, incorporating the Alvarado score. Br Med J 2000;321(7266):919. DOI: 10.1136/bmj.321.7266.919.
  6. Alvarado A. A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med 1986;15(5):557–564. DOI: 10.1016/s0196-0644(86)80993-3.
  7. Panait L, Bell RL, Duffy AJ, et al. Two-port laparoscopic appendectomy: minimizing the minimally invasive approach. J Surg Res 2009;153(1):167–171. DOI: 10.1016/j.jss.2008.02.003.
  8. Meljnikov I, Radonjic B, Grebe dinger S, et al. History of surgical treatment of appendicitis. Med Pregl 2009;62(9-10):489–492. Serbian.
  9. Ali R, Khan MR, Pishori T, et al. Laparoscopic appendectomy for acute appendicitis: is this a feasible option for developing countries? Saudi J Gastroenterol 2010;16(1):25–29. DOI: 10.4103/1319-3767.58764.
  10. Aguayo P, Alemayehu H, Desai AA, et al. Initial experience with same day discharge after laparoscopic appendectomy for nonperforated appendicitis. J Surg Res 2014;190(1):93–97. DOI: 10.1016/j.jss.2014.03.012.
  11. Hong TH, You YK, Lee KH. Trans umbilical single port laparoscopic cholecystectomy: scar less cholecystectomy. Surg Endosc 2009;23(6):1393–1397. DOI: 10.1007/s00464-008-0252-y.
  12. Lee SE, Choi YS, Kim BG, et al. Single port laparoscopic appendectomy in children using glove port and conventional rigid instruments. Ann Surg Treat Res 2014;86(1):35–38. DOI: 10.4174/astr.2014.86.1.35.
  13. Larson GM, Cheadle WG, Polk HC,Jr. Appendectomy for acute appendicitis. In: Ballantyne GH, Leahy PF, Modlin IM. Laparoscopic Surgery. Philadelphia: WB Saunders and Company; 1994. p. 220.
  14. Kavic MS. Laparoscopic appendectomy. In: Grochmal S. Minimal Access Gynaecology. Oxford: Radcliffe Medical Press; 1995. p. 149–162.
  15. Lofty M, Khairy MM, Moussa MS. Two-port laparoscopic appendectomy. European J Surg 2017;4:18–22.
  16. Yagnik VD, Rathod JB, Phatak AG. A retrospective study of two-port appendectomy and its comparison with open appendectomy and three-port appendectomy. Saudi J Gastroenterol 2010;16(4):268–271. DOI: 10.4103/1319-3767.70611.
  17. Two-port vs. three-port laparoscopic appendicectomy: A bridge to least invasive surgery Ashwin Rammohan, Paramaguru Jothishankar, A B Manimaran, and R M Naidu.
  18. Khan AR, Al-Bassam A. Two-port versus three-port laparoscopic appendectomy in children with uncomplicated appendicitis. Pead Endosurg Innov Tech 2002;6(4):255–260. DOI: 10.1089/109264102321111565.
  19. Olijnyk JG, Pretto GG, da Costa Filho OP, et al. Two-port laparoscopic appendectomy as transition to Laparo endoscopic single site surgery. J Minim Access Surg 2014;10(1):23–26. DOI: 10.4103/0972-9941.124460.
  20. Sauerland S, Lefering R, Neugebauer EA. Laparoscopic versus open surgery for suspected appendicitis. Cochrane Database Syst Rev 2004(4):CD001546. DOI: 10.1002/14651858.CD001546.pub2.
  21. Neugebauer EAM, Sauerland S, Fingerhut A, et al. EAES guidelines for endoscopic surgery: twelve years evidence-based surgery in Europe. Berlin: Springer; 2006. pp. 345–346.
  22. Li P, Chen Z-H, Li Q-G, et al. Safety and efficacy of single-incision laparoscopic surgery for appendectomies: a meta-analysis. World Journal of Gastroenterology: WJG 2013;19(25):4072–4082. DOI: 10.3748/wjg.v19.i25.4072.
  23. Donmez T, Hut A, Avaroglu H, et al. Two-port laparoscopic appendectomy assisted with needle grasper comparison with conventional laparoscopic appendectomy. Ann Surg Treat Res 2016;91(2):59–65. DOI: 10.4174/astr.2016.91.2.59.
  24. Lee J, Baek J, Kim W. Laparoscopic trans umbilical single-port appendectomy: initial experience and comparison with three-port appendectomy. Surg Laparo Endosc Percutan Tech 2010;20(2):100–103. DOI: 10.1097/SLE.0b013e3181d84922.
  25. Lee YS, Kim JH, Moon EJ, et al. Comparative study on surgical outcomes and operative costs of trans umbilical single-port laparoscopic appendectomy versus conventional laparoscopic appendectomy in adult patients. Surg Laparo Endosc Percutan Tech 2009;19(6):493–496. DOI: 10.1097/SLE.0b013e3181c15493.
  26. St Peter SD, Adibe OO, Juang D, et al. Single incision versus standard 3-port laparoscopic appendectomy: a prospective randomized trial. Ann Surg 2011;254(4):586–590. DOI: 10.1097/SLA.0b013e31823003b5.
  27. Park JH, Hyun KH, Park CH, et al. Laparoscopic vs trans umbilical single-port laparoscopic appendectomy; results of prospective randomized trial. J Korean Surg Soc 2010;78(4):213–218. DOI: 10.4174/jkss.2010.78.4.213.
  28. IOSR Journal of Dental and Medical Sciences 10.9790/0853-14382124 21 | Page Needle Port Assisted Two-Port Laparoscopic Appendicectomy Kiran Kumar KM, Naveen Kumar M, Srinivas Arava, Kishore Krishna, Pratheek KC.
  29. Chamberlain RS, Sakpal SV. A comprehensive review of single-incision laparoscopic surgery (SILS) and natural orifice transluminal endoscopic surgery (NOTES) technique for cholecystectomy. J Gastrointestinal Surg 2009;13(9):1733–1740. DOI: 10.1007/s11605-009-0902-y.
  30. Romanelli JR, Earle DB. Single-port laparoscopic surgery: an overview. Surg Endosc 2009;23(7):1419–1427. DOI: 10.1007/s00464-009-0463-x.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.