Original Article

J Minim Invasive Surg 2014; 17(1): 1-4

Published online January 15, 2014

https://doi.org/10.7602/jmis.2014.17.1.1

© The Korean Society of Endo-Laparoscopic & Robotic Surgery

복강경 충수절제술에서 투관침을 통한 충수제거를 위한 적절한 투관침 선택에 대한 연구

정창연1ㆍ배정민2

동국대학교 경주병원 외과1, 영남대학교 의과대학 외과학교실2

Received: November 12, 2013; Revised: January 23, 2014; Accepted: February 17, 2014

Trocar Size Selection for Trans-Trocar Appendix Removal in Laparoscopic Appendectomy

Chang Yeon Jung, M.D.1, Jung Min Bae, M.D.2

1Department of Surgery, Gyeongju Hospital, Dongguk University, Gyeongju, 2Department of Surgery, Yeungnam University College of Medicine, Daegu, Korea

Received: November 12, 2013; Revised: January 23, 2014; Accepted: February 17, 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Purpose: Many disposable laparoscopic instruments are used in laparoscopic surgery. There are several disadvantages in use of disposable laparoscopic instruments, including cost ineffectiveness, environmental contamination, and resource recycling. In addition, a disposable specimen bag has been used in laparoscopic appendectomy. Use of the trans-trocar appendix removal technique provides several advantages compared to use of a specimen bag. Therefore, the aim of this study is to analyze the adequate trocar size for trans-trocar appendix removal. Methods: A total of 62 patients undergoing appendectomy between June 2012 and September 2012 were identified. After appendectomy, we performed a trans-trocar test using re-moved appendix specimen and trocars. Three different types of trocars were used for the trans-trocar test, 5 mm, 12 mm, and 11 mm Xcel? (Ethicon). We analyzed the success rate. Results: Significant relationships were observed between maximal specimen diameter and body mass index. When BMI was below 20, the success rate of the 11 mm trocar was 86% in the trans-trocar appendix removal test. When BMI was between 20 and 25, the success rate of the 12 mm trocar was 71%, but that of 11 mm was 57%. When BMI was above 25, the success rate of the 15 mm trocar was 62%. Conclusion: Although this study had many limitations, a large-sized trocar was needed for trans-trocar appendix removal in more body mass index. When BMI is below 20, an 11 mm trocar is recommended in trans-trocar appendix removal. When BMI is between 20 and 25, a 12 mm trocar is. When BMI is above 25, a 15 mm trocar and a disposable specimen bag are recommended. Further continuous study will be needed for analysis of clinical outcome.

Keywords Laparoscopy, Appendectomy, Trocar

  1. Semm K. Endoscopic appendectomy. Endoscopy 1983;15:59-64.
    Pubmed CrossRef
  2. Bae JH, Jung KH, Jung HG, Ha DY, Bae JM. Comparison of Clinical Characteristics between Single Incision Laparoscopic Appendectomy. J Minim Invasive Surg 2013;16:52-55.
    CrossRef
  3. Tebala GD. Specimen removal after laparoscopic appendectomy:a cheap trick. Eur Rev Med Pharmacol Sci 2008;12:55-57.
    Pubmed
  4. Jain PK, Sedman P. Appendix retrieval after laparoscopic appendectomy:a safe and inexpensive technique. Surg Laparosc Endosc Percutan Tech 2003;13:322-324.
    Pubmed CrossRef
  5. Saad M. Fisherman's technique, introducing a novel method for using the umbilical port for removal of appendix during laparoscopic appendectomy. Surg Laparosc Endosc Percutan Tech 2007;17:422-424.
    Pubmed CrossRef
  6. Bhandarkar D, Shah R. A novel technique for extraction of the appendix in laparoscopic appendectomy. Surg Laparosc Endosc Percutan Tech 2002;12:117-118.
    Pubmed CrossRef
  7. Maa J. The appendix. In: Townsend Jr CM, Beauchamp RD, Evers BM, Mattox KL, editors. Sabiston Textbook of Surgery:Expert Consult Premium Edition: Enhanced Online Features. 19th ed. Philadelphia: Elsevier Health Sciences; 2012. p. 1281.
    CrossRef
  8. Lally KP. Appendix. In: Townsend CM, Sabiston DC, editors. Sabiston textbook of surgery : the biological basis of modern surgical practice. 16th ed. Philadelphia: W.B. Saunders Co.;2001. p. 925.
  9. Birnbaum BA, Wilson SR. Appendicitis at the millennium. Radiology 2000;215:337-348.
    Pubmed CrossRef
  10. Jaffe BM. The Appendix. In: Brunicardi FCSSI, editor. Schwartz's principles of surgery. 9th ed. New York: McGrawHill;2010. p. 1078.

Article

Original Article

J Minim Invasive Surg 2014; 17(1): 1-4

Published online January 15, 2014 https://doi.org/10.7602/jmis.2014.17.1.1

Copyright © The Korean Society of Endo-Laparoscopic & Robotic Surgery.

복강경 충수절제술에서 투관침을 통한 충수제거를 위한 적절한 투관침 선택에 대한 연구

정창연1ㆍ배정민2

동국대학교 경주병원 외과1, 영남대학교 의과대학 외과학교실2

Received: November 12, 2013; Revised: January 23, 2014; Accepted: February 17, 2014

Trocar Size Selection for Trans-Trocar Appendix Removal in Laparoscopic Appendectomy

Chang Yeon Jung, M.D.1, Jung Min Bae, M.D.2

1Department of Surgery, Gyeongju Hospital, Dongguk University, Gyeongju, 2Department of Surgery, Yeungnam University College of Medicine, Daegu, Korea

Received: November 12, 2013; Revised: January 23, 2014; Accepted: February 17, 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose: Many disposable laparoscopic instruments are used in laparoscopic surgery. There are several disadvantages in use of disposable laparoscopic instruments, including cost ineffectiveness, environmental contamination, and resource recycling. In addition, a disposable specimen bag has been used in laparoscopic appendectomy. Use of the trans-trocar appendix removal technique provides several advantages compared to use of a specimen bag. Therefore, the aim of this study is to analyze the adequate trocar size for trans-trocar appendix removal. Methods: A total of 62 patients undergoing appendectomy between June 2012 and September 2012 were identified. After appendectomy, we performed a trans-trocar test using re-moved appendix specimen and trocars. Three different types of trocars were used for the trans-trocar test, 5 mm, 12 mm, and 11 mm Xcel? (Ethicon). We analyzed the success rate. Results: Significant relationships were observed between maximal specimen diameter and body mass index. When BMI was below 20, the success rate of the 11 mm trocar was 86% in the trans-trocar appendix removal test. When BMI was between 20 and 25, the success rate of the 12 mm trocar was 71%, but that of 11 mm was 57%. When BMI was above 25, the success rate of the 15 mm trocar was 62%. Conclusion: Although this study had many limitations, a large-sized trocar was needed for trans-trocar appendix removal in more body mass index. When BMI is below 20, an 11 mm trocar is recommended in trans-trocar appendix removal. When BMI is between 20 and 25, a 12 mm trocar is. When BMI is above 25, a 15 mm trocar and a disposable specimen bag are recommended. Further continuous study will be needed for analysis of clinical outcome.

Keywords: Laparoscopy, Appendectomy, Trocar

References

  1. Semm K. Endoscopic appendectomy. Endoscopy 1983;15:59-64.
    Pubmed CrossRef
  2. Bae JH, Jung KH, Jung HG, Ha DY, Bae JM. Comparison of Clinical Characteristics between Single Incision Laparoscopic Appendectomy. J Minim Invasive Surg 2013;16:52-55.
    CrossRef
  3. Tebala GD. Specimen removal after laparoscopic appendectomy:a cheap trick. Eur Rev Med Pharmacol Sci 2008;12:55-57.
    Pubmed
  4. Jain PK, Sedman P. Appendix retrieval after laparoscopic appendectomy:a safe and inexpensive technique. Surg Laparosc Endosc Percutan Tech 2003;13:322-324.
    Pubmed CrossRef
  5. Saad M. Fisherman's technique, introducing a novel method for using the umbilical port for removal of appendix during laparoscopic appendectomy. Surg Laparosc Endosc Percutan Tech 2007;17:422-424.
    Pubmed CrossRef
  6. Bhandarkar D, Shah R. A novel technique for extraction of the appendix in laparoscopic appendectomy. Surg Laparosc Endosc Percutan Tech 2002;12:117-118.
    Pubmed CrossRef
  7. Maa J. The appendix. In: Townsend Jr CM, Beauchamp RD, Evers BM, Mattox KL, editors. Sabiston Textbook of Surgery:Expert Consult Premium Edition: Enhanced Online Features. 19th ed. Philadelphia: Elsevier Health Sciences; 2012. p. 1281.
    CrossRef
  8. Lally KP. Appendix. In: Townsend CM, Sabiston DC, editors. Sabiston textbook of surgery : the biological basis of modern surgical practice. 16th ed. Philadelphia: W.B. Saunders Co.;2001. p. 925.
  9. Birnbaum BA, Wilson SR. Appendicitis at the millennium. Radiology 2000;215:337-348.
    Pubmed CrossRef
  10. Jaffe BM. The Appendix. In: Brunicardi FCSSI, editor. Schwartz's principles of surgery. 9th ed. New York: McGrawHill;2010. p. 1078.

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