Single-Incision Laparoscopic Appendectomy Using a Wound Retractor and Surgical Glove

Abstract

Introduction:

Single-incision laparoscopic surgery has become increasingly popular in children. The expense incurred from using commercial single-incision access devices for commonly performed operations is significant. Therefore, we adapted a previously described homemade glove port for pediatric appendectomy to reduce costs. ^1,2

Materials and Methods:

We describe the construction of a homemade glove port. In this video, we utilized a 5-mm port in the thumb and 3-mm ports in the index and small fingers, respectively. Reusable ports are secured to each finger using a red rubber catheter and ties. Any combination of port sizes is possible depending on surgeon preference. A transumbilical or periumbilical incision is created and a 1- to 1.5-cm fascial incision is needed. An Alexis wound protector/retractor (Applied Medical, Rancho Santa Margarita, CA) is placed and the glove rolled onto the external ring. In this case, the cecum was mobilized and the mesoappendix divided using electrocautery. The appendix was exteriorized for ligation; however, use of a stapler or endoscopic loops is possible.

Results and Conclusions:

To date, we have performed 92 single-incision appendectomies using the glove port. Perforated appendicitis was diagnosed in 28% of cases. Two patients required the addition of one additional port. Operative time is 7 minutes longer than laparoscopic appendectomy, whereas operating room cost has been reduced by $200 USD as compared with standard laparoscopic appendectomy. We have not had an umbilical wound infection thus far despite not using a retrieval bag. We believe that single-incision laparoscopic appendectomy using a wound retractor and surgical glove for access represents an effective and economical alternative to laparoscopic appendectomy.

The author has no financial conflicts to disclose.

Runtime of video: 4 mins 28 secs

Previous presentations: This video was presented at the 2nd Annual Tricks of the Trade & Difficult Cases in Pediatric Surgery Interactive Web Symposium 03/2011.