Microlaparoscopically Assisted Appendectomy: The Best of Both Worlds

Abstract

ABSTRACT

Background

: Despite providing excellent visibility and a short recovery period, laparoscopic appendectomy incurs higher hospital costs and is technically more demanding than open appendectomy. This paper describes an alternative technique for appendectomy that combines the beneficial aspects of the laparoscopic and open techniques.

Methods

: The microlaparoscopic appendectomy (MA) technique uses a 2-mm laparoscope and one or two additional 2-mm ports (suprapubic and, if necessary, left lower quadrant) to assist in localizing and mobilizing the appendix. A 1-cm right lower quadrant incision is made, and under direct vision, the appendix is grasped with a nontraumatic clamp and brought out of the abdomen through the abdominal wall. The abdomen is deflated, and routine appendectomy is performed. Once the appendix has been removed, the abdomen is reinsufflated, the stump and mesentery are inspected, and the abdomen is irrigated under direct vision.

Results

: In one series of 13 patients, there were no complications, and the average postoperative stay was just over 24 hours. Anesthesia time averaged 90 minutes (range 60–145 minutes). Use of laparoscopy provided supplementary diagnoses and procedures in five patients. The cost difference between MA and open appendectomy was minimal. All patients were enthusiastic about their cosmetic results.

Conclusion

: The MA technique combines excellent laparoscopic visibility and superior cosmetic results with technical facilitation and cost-effectiveness of the open technique.