Study record managers: refer to the Data Element Definitions if submitting registration or results information. Treatment of choice is the surgical removal of the inflamed appendix by using open or laparoscopic appendectomy.
Following laparoscopic appendectomy LA proved to be a feasible and at least as safe as the corresponding open procedure, it has rapidly gained worldwide acceptance. The traditional approach to LA uses three ports.
Over the past decade, successful attempts to perform the procedure with fewer ports have been reported. The authors' primary objectives were to 1 identify a simple, safe and feasible way to perform laparoscopic appendectomy in patients with uncomplicated acute appendicitis.
Until the first laparoscopic removal of an inflamed appendix by Kurt Semm in , the gold standard for surgical treatment of acute appendicitis remained open appendectomy as first described by McBurney in At the beginning, LA remained questionable whether the benefits of the procedure outweigh over its disadvantages. However, since laparoscopic technology advances and surgeons' expertise increases, many surgeons have successfully performed a multitude of laparoscopic procedures for AA, with a continued increasing trend in its use.
Eventually, after LA proved to be a feasible and at least as safe as the corresponding open procedure, it has rapidly gained worldwide acceptance. There are more techniques for LA in the literature but only a few of them have gained to access and described in modern textbooks.
Over the past decade, successful attempts to perform the procedure with fewer ports have been reported which include two-port techniques, single-port techniques, and hybrid approaches. The two-port appendectomy technique consist of one port providing access for a rigid telescope with a working channel, and second port for a grasping forceps that is used to retract the appendix. In the single-port assisted technique, after a stitch is placed between the appendix and the anterior abdominal wall to pull the appendix and create a tension to facilitate dissection, and then appendectomy is performed intracorporeally.
The hybrid technique formed from the combination of both open and laparoscopic approaches. Namely the appendix is pulled out through the only or one of the port, and a traditional open appendectomy is then performed extracorporeally. For these purposes, a case-control study was designed in January to investigate these issues.
Total laparoscopic appendectomy or laparoscopic assisted appendectomy Other Name: laparoscopic assisted appendectomy Lap Assisted App Patients with the diagnosis of acute appendicitis who underwent a successful laparoscopic assisted appendectomy Procedure: Laparoscopic appendectomy Two types of laparoscopic surgery were performed.
Total laparoscopic appendectomy or laparoscopic assisted appendectomy Other Name: laparoscopic assisted appendectomy Advanced to TLA Patients with the diagnosis of acute appendicitis in whom laparoscopic assisted appendectomy attempted; however, because it fail advanced to total laparoscopic appendectomy. Procedure: Laparoscopic appendectomy Two types of laparoscopic surgery were performed. Talk with your doctor and family members or friends about deciding to join a study.
To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies. Jacopo Berengario da Carpi gave the first description of this structure in Gabriele Fallopio, in , appears to have been the first writer to compare the appendix to a worm.
In Caspar Bauhin proposed the ingenious theory that the appendix served in intrauterine life as a receptacle for the faexes. Many of anatomists added more or less insignificant ideas concerning the structure of the appendix and entered upon useless controversy concerning the name, function, position of the appendix vermiformis. The first successful appendectomy was performed in by Claudius Amyand.
Geillaume Dupuytren considered that acute inflammation of the right side of the abdomen arose from disease of the caecum and not the appendix. After LA, patients are 3 times more likely to have an intra-abdominal abscess.
Bonnani et al. As well, operating time for LA is about 10 minutes longer than with a laparotomy. However, recent studies have shown that as experience with laparotomy increases, operating time has decreased, culminating in LA being only approximately 5 minutes longer [ 12 ]. LA is also a more expensive surgery than its conventional counterpart. Of note, Sauerland et al. The authors state that since LA has the ability to be diagnostic, there are situations in which an appendectomy was never carried out, biasing the results towards faster operating times.
As well, they argue that the stated reduction in hospital stay and pain scores seen in LA, while statistically significant, perhaps are not clinically significant [ 11 ]. It is safe to say that many important patient and institution factors need to be taken into consideration for the decision algorithm of which type of intervention to perform.
These include but are not limited to what equipment is available, the level of experience of the operator, the severity of the appendicitis and likelihood of post-operative complications. In , Pelosi first described a single-puncture laparoscopic appendectomy in 25 patients [ 27 ]. However, it was not until the last few years that this new minimally invasive technique called the single incision laparoscopic appendectomy SILA really caught on.
It has been proposed as the next major breakthrough in the appendectomy evolution. The surgical technique for SILA is not yet standardized, with great institutional procedural variation. In addition, a needlescopic instrument can be placed percutaneously in the right iliac fossa for assistance in supporting the appendix [ 28 ]. Either rigid conventional laparoscopic instruments can be used or special bendable instruments [ 28 , 30 , 31 ].
The mesoappendix is then divided with the appendiceal artery cauterized and the base of the appendix ligated with an Endloop. There was, however, an RCT of 40 patients comparing the standard laparoscopic cholecystectomy versus single incision laparoscopic cholecystectomy, looking at pain scores after surgery. It was found that single incision patients reported significantly less post-operative abdominal pain [ 35 ]. However, in contrast to what was expected, Chow et al. This paradoxical finding was largely felt to be attributed to the staff surgeon usually performing the appendectomies over the learner, as most residents are not yet comfortable with elements of SILA—the limitation in instrument triangulation, the increased susceptibility of instrument collisions, and a reduction in the visual field [ 33 , 36 ].
There is already new literature that is orientated to improving upon these limitations. One of the proposed mechanisms is called the magnetic anchoring guidance system, which involves a magnet and camera apparatus that can move unrestricted intra-abdominally, not relying on a fixed camera port thereby limiting instrument collision and restoring some of the natural triangulation seen with LA [ 33 ].
As stated earlier, SILA can be performed using specialized equipment or with conventional ones. The specialized equipment can put a strain on hospital resources, as they are more expensive, making SILA a more impractical procedure [ 37 ]. It appears that these two techniques have similar outcomes, but an RCT is required to be fully comfortable with comparison. An operation can be started using the single incision approach and depending on how complicated the appendectomy appears; ports may be added to convert the procedure to LA [ 38 ].
SILA is only a stepping stone to what lies ahead for minimally invasive surgery, possibly to a technique called natural orifice translumenal endoscopic surgery NOTES , which involves no external scarring [ 36 ].
However, while minimally invasive surgery continues to make great strides, it is important to recognize that perhaps the best surgical intervention for appendicitis is no surgery at all. There is growing evidence in the literature promoting conservative treatment of appendicitis, strictly with antibiotics. Varadhan et al. Minimally invasive surgery will continue to push the limits. Switzer et al. This is an open access article distributed under the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Article of the Year Award: Outstanding research contributions of , as selected by our Chief Editors. Read the winning articles. Journal overview. Special Issues. Switzer, 1 Richdeep S. Academic Editor: M. Received 02 May Accepted 20 May Published 12 Jul Abstract Beginning with its initial description by Fitz in the 19th century, acute appendicitis has been a significant long-standing medical challenge; today it remains the most common gastrointestinal emergency in adults.
Discussion 2. Open Appendectomy McBurney is credited with consolidating the surgical technique of the open appendectomy OA in , an approach that has not significantly changed in the last years [ 5 ]. Special Populations Four special populations, in particular, have potentially benefited from laparoscopic intervention—women, the morbidly obese, pediatrics, and geriatrics.
Single Incision Laparoscopic Appendectomy In , Pelosi first described a single-puncture laparoscopic appendectomy in 25 patients [ 27 ]. Future Techniques SILA is only a stepping stone to what lies ahead for minimally invasive surgery, possibly to a technique called natural orifice translumenal endoscopic surgery NOTES , which involves no external scarring [ 36 ].
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Sauerland, R.
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