Minilaparoscopic appendectomy using a needle loop retractor offers optimal cosmetic results

Excerpt

We read the paper of Sato et al. about the use of minilaparoscopic instruments to perform laparoscopic appendectomy with great interest. Their main objective was to obtain better cosmesis than after normal laparoscopic appendectomy. To obtain even better cosmetic results, we want to describe our one-trocar technique. For this technique we use a special 10-mm zero-degree Storz telescope. This special telescope is a combination of a scope and a working channel. A pneumoperitoneum is installed at the umbilicus in an open fashion and in rare cases at the lower right quadrant. After introduction of the telescope the abdominal cavity is inspected and the inflamed appendix is grasped. When the appendix is located dorsally to the cecum, the one trocar appendectomy is generally not possible. Under these circumstances inserting another instrument is necessary to retract the cecum. This can be performed with 2-mm instruments. Through the telescope the tip of the appendix is grasped and the appendix is removed from the abdomen together with the telescope after the pneumoperitoneum is released. The mesoappendix is ligated extracorporally. To allow good exposure the abdominal wall is retracted by narrow shaped retractors. The appendix is transected after ligation. After completion of the appendectomy, the Hasson’s trocar is reinserted to allow laparoscopic inspection of the peritoneal cavity and appendiceal stump. Remaining fluid can be aspirated and irrigation can be performed. However, it is not always possible in adults to get enough mobilization of the cecum to retract the appendix outside the abdomen, especially in patients with a lot of subcutaneous fat. This technique is a very good alternative in children and slim patients. …