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Published on: June 16, 2023
Laparoscope-assisted appendectomy in children: the two-trocar technique
I Valioulis1, F Hameury, L Dahmani
1Department of Paediatric Surgery, University Hospital of Poitiers, Poitiers, France. ioannisvalioulis@hotmail.com
Summary
This modified laparoscopic appendectomy technique improves appendix visualization, especially in children. The extraabdominal approach offers a viable alternative with reduced complications and time.
Area of Science:
- Surgical Innovation
- Minimally Invasive Surgery
- Pediatric Surgery
Background:
- Conventional laparoscopic appendectomy cannulae placement hinders visualization of the appendix, particularly in retrocaecal or pelvic positions.
- The limited space within the peritoneal cavity in children exacerbates visualization challenges during laparoscopic appendectomy.
Purpose of the Study:
- To propose and evaluate a modified cannulae position for extraabdominal appendectomy to enhance appendix visualization.
- To assess the efficacy and safety of this modified technique, especially in pediatric patients.
Main Methods:
- A modified technique involving two trocars (umbilical and suprapubic) was employed for extraabdominal appendectomy.
- The telescope was inserted through the suprapubic trocar, and the appendix was exteriorized via the umbilical incision for conventional appendectomy.
Main Results:
- The modified technique was successful in 76.3% of 38 cases, with a mean operation time of 19 minutes.
- A third trocar was needed in 9 patients with challenging appendix positions or peritonitis. Conversion rates were low (5.2%), and infectious complications were minimal.
Conclusions:
- The enhanced visualization provided by this method leads to significant time savings.
- This extraabdominal appendectomy technique is a safe and effective alternative, particularly beneficial for pediatric appendectomies due to improved anatomical access.
