Kengo Kai, MD, Takuto Ikeda, MD, Akiko Ichihara, MD, Roko Hamada, MD, Kenzo Nagatomo, MD, Satoshi Matsuzawa, MD, Junko Ushijima, MD, Seishi Furukawa, MD, Hiroshi Sameshima, MD, Atsushi Nanashima, MD
Department of Surgery, University of Miyazaki Faculty of Medicine, Kiyotake, Miyazaki City, Miyazaki, Japan (Drs Kai, Ikeda, Ichihara, Hamada, Nagatomo, and Nanashima).
Department of Obstetrics and Gynecology, University of Miyazaki Faculty of Medicine, Kiyotake, Miyazaki City, Miyazaki, Japan (Drs Matsuzawa, Ushijima, Furukawa, and Sameshima).
Introduction: Acute appendicitis is the most common general surgical problem during pregnancy. Laparoscopic appendectomy has been gaining widespread popularity and has been accepted as a minimally invasive surgery based on evidence for its use in appendicitis in pregnant patients. However, the gravid uterus in the third trimester and the frequent suction required for abscess drainage make the working space intractable.
Case Description: We report a case in which an AirSeal intelligent flow system (ASIFS) (CONMED Corporation, Utica, NY, USA) was useful for laparoscopic appendectomy and abscess drainage for perforated appendicitis in a 31-wk pregnant patient. ASIFS allowed successful maintenance of a working space, thus making it possible to excise the appendix at its base with double ligation and effectively drain the abscess with no maternal and fetal complications. To our knowledge, there have been no reports of the use of ASIFS in a pregnant patient. A past study reported that ASIFS could induce hypothermia compared with a conventional CO2 supply tube in patients. Although intraoperative hypo- thermia did not occur in our patient, it would be prudent to carefully avoid frequent suctioning in the short term and to warm the patient intraoperatively because maternal and fetal bodies are susceptible to change in hemodynamics.
Conclusion: Surgeons should consider the use of ASIFS before deciding to convert from laparoscopic appendectomy to an open procedure in pregnant patients.
Key Words: laparoscopic appendectomy, perforated appendectomy, third trimester, AirSeal intelligent flow system.