Gloved Appendectomy Performed With a Gloved Single Incision Laparoscopic Surgery Technique Versus Conventional Multiport Laparoscopic Technique

Bin Chet Toh, MBChB, MRCS, Quor Meng Leong, MBBS, MRCS, MMed, FRCSEdDepartment of General Surgery, Tan Tock Seng Hospital, Jalan Tan Tock Seng, Singapore (both authors).

ABSTRACT

Introduction: Using a commercially available multichannel port for single incision laparoscopic surgery (SILS) can be cost prohibitive to the development of this novel surgical technique. The use of a glove and Alexis wound protector allows laparoscopic surgeons to perform glove single incision laparoscopic surgery (G-SILS) at lower cost.

Objectives: This study sought to evaluate the feasibility and safety of the G-SILS technique as an alternative surgical procedure for appendectomy and to present a comparison between G-SILS with conventional multiport laparoscopic (CML) technique in terms of operative outcomes.

Materials and Methods: This was a case-control study to compare G-SILS and CML techniques in appendectomy. This is a retrospective analysis of all appendectomies done using the G-SILS technique by single surgeon from January 1, 2011, to December 31, 2012. It was performed to evaluate an initial experience of this surgical approach. Parameters for analysis include duration of surgery, conversion rate, perioperative complications, postoperative length of stay, and 6-month follow-up outcome. The control group of patients were specifically matched with respect to patient’s age and sex before analysis of surgical outcomes to serve as the best comparison cohort.

Results: G-SILS was successfully performed in 18 patients (7 female, 11 male) with acute appendicitis versus CML group with 18 patients (8 female, 10 male). The mean age of the G-SILS case study group was 35 ± 15.4 years, and for the CML control group, mean age was 35 ± 15.1 years. The mean operative time of the G-SILS technique is slightly longer than that of the CML technique (55 ± 14.1 minutes vs 45 ± 10.2 minutes, P=.053). The mean postoperative length of hospital stay is almost similar for both groups (1.3 ± 0.6 days vs 1.1 ± 0.3 days, P= .104). There were no conversion, perioperative, or 6-month postoperative complications observed in either group.

Conclusions: The use of glove and Alexis wound protector for G-SILS is relatively safe. It is a feasible alternative surgical approach for appendectomy.

Key Words: Conventional multiport laparoscopy, Glove technique single incision laparoscopic appendectomy.

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