Ann Surg Treat Res.  2014 May;86(5):278-282. 10.4174/astr.2014.86.5.278.

The experience of transumbilical endoscopic appendectomies

• Lee CH
• Jeon WJ
• Youn SJ
• Yun HY
• Jang LC
• Choi JW
• Song YJ
• Ryu DH

• KMID: 1889667
• DOI: http://doi.org/10.4174/astr.2014.86.5.278

Abstract

Minimally invasive surgery is being widely accepted in various fields of surgery. Although several appendectomy techniques have been reported but, there is no standardization. We report here the experiences of transumbilical endoscopic appendectomy in humans. Between July 2008 and September 2010, ten patients with appendicitis successfully underwent transumbilical endoscopic appendectomies. There were 7 cases of suppurative, 2 cases of gangrenous and 1 case of perforated in operative findings. The ages of the patients were 13-56 years (mean age, 32.7 +/- 15.4 years). Under general anesthesia, a 15-mm port was inserted through the umbilicus and then a two-channel endoscope was inserted in the peritoneal cavity. After appendix identification, counter-traction of the appendix with a direct abdominal wall puncture using a straight round needle prolene was performed to achieve good visualization of the operative field. Tissue dissection was performed using an endoscopic needle knife. Tissue grasping and resected appendix retrieval were done with endoscopic forceps. The average operation time was 79.5 +/- 23.6 minutes (range, 45 to 110 minutes). No procedures were converted to laparoscopic or open appendectomy. Hospital stay was 4-6 days. All patients completely recovered without complications. As it is highly maneuverable, we believe transumbilical endoscopic appendectomy can be a feasible method. And, as surgeons want to proceed from laparoscopic surgery to natural orifice transluminal endoscopic surgery, this procedure could be a triable method.

Keyword

Appendectomy; Transumbilical approach; Endoscopy

MeSH Terms

Abdominal Wall
Anesthesia, General
Appendectomy*
Appendicitis
Appendix
Endoscopes
Endoscopy
Hand Strength
Humans
Laparoscopy
Length of Stay
Natural Orifice Endoscopic Surgery
Needles
Peritoneal Cavity
Polypropylenes
Punctures
Surgical Instruments
Surgical Procedures, Minimally Invasive
Umbilicus
Polypropylenes

Figure

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  Fig. 1 (A) Unit; LUCERA CLV-260 (Olympus). (B) Endoscope GIF-2TQ 260M (Olympus). Adapted with permission by Olympus Co.

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  Fig. 2 Operative findings. (A) Traction tie (arrow) of appendix tip. (B) Mesoappendix: appendiceal artery clip ligation. (C) Appendiceal stump (arrowhead): clip ligation & endoscopic loop ligation.

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  Fig. 3 The postoperative image of a patient treated with transumbilical endoscopic appendectomy.

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