Oscar Vidal1, Cesar Ginestà, Mauro Valentini, Josep Martí, Guerson Benarroch, Juan C García-Valdecasas. 1. General Surgery and Emergency Unit, Department of General and Digestive Surgery, Digestive Diseases and Metabolism Institute, Hospital Clínic i Provincial, Universitat de Barcelona, Villarroel 170, 9th stair, 4th floor, 08036 Barcelona, Spain. ovidal@clinic.ub.es
Abstract
BACKGROUND: At the present time, and given the increasing concern about body image, laparoscopic surgeons are faced with an increasing number of patients who want to conserve the umbilicus free of scars for cosmetic reasons. Single-incision laparoscopic surgery (SILS) using the suprapubic approach for appendectomy, while keeping the advantages of SILS through an umbilical incision, leaves the visible abdomen without scars. Moreover, insertion of an additional port in patients with retrocecal or purulent or gangrenous acute appendicitis requiring intra-abdominal drainage is avoided. This report describes the initial experience with suprapubic SILS appendectomy. METHODS: Between September 2009 and December 2010, patients with acute appendicitis admitted to the General Surgery and Emergency Unit of the authors' institution and who agreed to undergo SILS appendectomy through the suprapubic approach were included in a prospective study. Demographics, clinical characteristics, and surgical outcome were recorded. RESULTS: A total of 20 patients (12 men and 8 women) with a mean age of 30 ± 3 years underwent suprapubic SILS appendectomy. The mean duration of the operation was 40 ± 7 min. Placement of a suction drain was necessary in four patients. The mean length of hospital stay was 2 ± 0.5 days. The operation was completed successfully in all patients, and conversion to either multiport or open surgery was not required. No intraoperative or postoperative complications occurred. In all patients, the appearance of the suprapubic wound was good at 7 days after surgery. CONCLUSION: Suprapubic SILS appendectomy offers better, cosmetically appealing results than the standard umbilical access. In case of retrocecal or purulent or gangrenous acute appendicitis, the view provided via the suprapubic approach makes access to and dissection of the appendix easy, and it also enables exteriorization of a drain without adding new lateral incisions.
BACKGROUND: At the present time, and given the increasing concern about body image, laparoscopic surgeons are faced with an increasing number of patients who want to conserve the umbilicus free of scars for cosmetic reasons. Single-incision laparoscopic surgery (SILS) using the suprapubic approach for appendectomy, while keeping the advantages of SILS through an umbilical incision, leaves the visible abdomen without scars. Moreover, insertion of an additional port in patients with retrocecal or purulent or gangrenous acute appendicitis requiring intra-abdominal drainage is avoided. This report describes the initial experience with suprapubic SILS appendectomy. METHODS: Between September 2009 and December 2010, patients with acute appendicitis admitted to the General Surgery and Emergency Unit of the authors' institution and who agreed to undergo SILS appendectomy through the suprapubic approach were included in a prospective study. Demographics, clinical characteristics, and surgical outcome were recorded. RESULTS: A total of 20 patients (12 men and 8 women) with a mean age of 30 ± 3 years underwent suprapubic SILS appendectomy. The mean duration of the operation was 40 ± 7 min. Placement of a suction drain was necessary in four patients. The mean length of hospital stay was 2 ± 0.5 days. The operation was completed successfully in all patients, and conversion to either multiport or open surgery was not required. No intraoperative or postoperative complications occurred. In all patients, the appearance of the suprapubic wound was good at 7 days after surgery. CONCLUSION: Suprapubic SILS appendectomy offers better, cosmetically appealing results than the standard umbilical access. In case of retrocecal or purulent or gangrenous acute appendicitis, the view provided via the suprapubic approach makes access to and dissection of the appendix easy, and it also enables exteriorization of a drain without adding new lateral incisions.
Authors: Oscar Vidal; Mauro Valentini; Cesar Ginestà; Guerson Benarroch; Juan Carlos García-Valdecasas Journal: Cir Esp Date: 2009-03-14 Impact factor: 1.653
Authors: Oscar Vidal; Mauro Valentini; Cesar Ginestà; Josep Martí; Juan J Espert; Guerson Benarroch; Juan C García-Valdecasas Journal: Surg Endosc Date: 2009-08-19 Impact factor: 4.584
Authors: Tae Ho Hong; Hyung Lan Kim; Yoon Suk Lee; Jin Jo Kim; Keun Ho Lee; Young Kyoung You; Se Jeong Oh; Seung Man Park Journal: J Laparoendosc Adv Surg Tech A Date: 2009-02 Impact factor: 1.878
Authors: Ramon Vilallonga; Umut Barbaros; Ahmed Nada; Aziz Sümer; Tuğrul Demirel; José Manuel Fort; Oscar González; Manuel Armengol Journal: Minim Invasive Surg Date: 2012-05-13