Is less more? A prospective trial on one trocar appendectomy

Area of Science:

• Minimally Invasive Surgery
• Surgical Techniques
• Gastrointestinal Surgery

Background:

• Traditional appendectomy involves open or multi-trocar laparoscopic approaches.
• One trocar appendectomy combines laparoscopic and open techniques, potentially reducing incisions and improving cosmetic outcomes.
• The technique allows instrument introduction through the optical trocar, minimizing additional incisions.

Purpose of the Study:

• To evaluate the efficacy and safety of the one trocar appendectomy technique in daily practice for patients with suspected acute appendicitis.
• To assess the feasibility of performing appendectomy using a single trocar.
• To determine the rate of success and need for additional trocars or conversion to open surgery.

Main Methods:

• A prospective study was conducted on a cohort of consecutive patients diagnosed with suspected acute appendicitis.
• The one trocar appendectomy procedure was performed on all enrolled patients.
• Data collected included operative time, success rate, need for additional trocars, conversion rates, and complications.

Main Results:

• The one trocar appendectomy was successfully completed in 13 out of 22 patients.
• Eight patients required an additional trocar (2, 5, or 10 mm), and one patient needed a third trocar.
• No conversions to open appendectomy were necessary; the diagnosis of acute appendicitis was confirmed in all cases. Average operation time was 53 minutes.

Conclusions:

• One trocar appendectomy is a safe and effective surgical option for suspected acute appendicitis.
• Successful implementation requires an experienced surgical team proficient in laparoscopic surgery and patient selection based on suitable physical constitution.
• The technique offers potential benefits in terms of cosmesis and reduced invasiveness.