Laparoscope-assisted appendectomy in adults: the two-trocar technique

BACKGROUND: Open appendectomy is still the most common method of treating appendicitis. Laparoscopic procedures for removal of the appendix by the “in” technique as an alternative to conventional appendectomy have gained wide popularity, but have been criticized for their technical difficulty and high cost. We assessed the safety and efficacy of the laparoscope-assisted appendectomy (the two-trocar technique) in adults. PATIENTS AND METHODS: We retrospectively studied 129 patients who had appendectomy using the laparoscope-assisted two-trocar technique between July 2002 to December 2003. The procedures were done by consultants and surgeons-in-training with experience in minimally invasive and open techniques. Locally modified endoloop and reusable trocars were used to reduce the cost. Appendectomy was performed extra-abdominally after the appendix was identified by using a laparoscope through one port and then delivered outside through the second port using reusable laparoscopy instruments. RESULTS: The two-trocar technique was successful in 101 (78.3%) cases; 14 (10.8%) needed a third trocar to complete the operation extra-abdominally, 6 (4.6%) were converted to open surgery, and 5 (3.8%) had an intra-abdominal laparoscopic appendectomy. The mean operation time was 35 minutes (range, 30–90 minutes). Six cases (4.6%) had infection. The mean hospital stay was 2.8 days (range, 2–7 days). No case of port hernia was reported during the follow-up period (range, 14–30 months). CONCLUSION: The laparoscope-assisted two-trocar technique for removal of the appendix can be performed as safely and efficiently as the open technique, but at a lower cost than the complete laparoscopic ‘in” method and does not need much technical expertise. This method is recommended as an alternative procedure to open appendectomy or the complete laparoscopic “in” technique in adults.