Bonatti Hugo J R
University of Maryland Community Medical Group, Surgical Services, Easton, MD, USA.
Meritus Surgical Specialists, Hagerstown, MD, USA.
Minim Invasive Surg. 2019 May 19;2019:9761968. doi: 10.1155/2019/9761968. eCollection 2019.
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.
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).
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.
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.
腹腔镜阑尾切除术（LA）最常通过两个5毫米和一个10/12毫米的端口进行。人们已进行了各种减少端口数量和尺寸的尝试，并引入了诸如单孔LA等新技术。阑尾和阑尾系膜通常用吻合器或能量设备进行分离，电灼、夹子和内镜圈套器是较便宜的选择。
本研究纳入了一家乡村医院连续进行的51例LA手术。患者分为4组：第1组为标准技术组（n = 12），第2组作为“试验组”（n = 12），第3组作为可行性组（n = 12），第4组是最终的患者队列，其中优选使用优化技术（n = 15）。
研究队列的中位年龄为35.4岁（范围：6.2 - 80.6岁），55%的患者为男性。在第1组中，所有患者均采用标准端口置入（10/12毫米，2个5毫米），而在第2 - 4组中，越来越多的患者仅插入两个5毫米端口和2.3毫米的泰利福微型抓钳。吻合器和/或能量设备的使用从第1组的100%降至第4组的20%，并且在大多数情况下，阑尾和血管蒂均用内镜圈套器固定。新技术未增加手术时间或总手术时长。本系列中未出现残端漏或手术部位感染，也没有转为开放手术的情况。不使用吻合器或能量设备时，每例节省成本约400美元；微型抓钳使每例成本增加约200美元。
在大多数情况下，使用两个端口和无端口针式抓钳进行LA是可行的，并且患者满意度高，美容效果极佳。避免使用能量设备和吻合器可节省成本；内镜圈套器能可靠地控制阑尾和阑尾系膜。
