New curved and reusable instruments for single access laparoscopic appendectomy

Surgeons are always looking for the most effective and least invasive techniques to benefit patients. The single incision laparoscopic surgery (SILS) is revolutionary in the gastrointestinal surgical field. Specific tools are used in this kind of surgery. This video shows a SILS appendectomy performed with specific curved instruments.

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New curved and reusable instruments for single access laparoscopic appendectomy

Authors

G Dapri, L Casali, J Himpens, GB Cadière

Abstract

Surgeons are always looking for the most effective and least invasive techniques to benefit patients. The single incision laparoscopic surgery (SILS) is revolutionary in the gastrointestinal surgical field. Specific tools are used in this kind of surgery. This video shows a SILS appendectomy performed with specific curved instruments.

Classification

single port, contribution

Keywords

New curved, reusable instruments, single access laparoscopic appendectomy

Media type

Surgical video

Duration

04'59''

Publication

2010-03

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E-publication

WeBSurg.com, Mar 2010;10(03).
URL: http://www.websurg.com/doi-vd01en2910.htm

New curved and reusable instruments for single access laparoscopic appendectomy

1. Introduction 00'18''

Single incision laparoscopic appendectomy is performed by incising the umbilical fold, cutting down to the peritoneum, and once the peritoneum has been entered by placing a purse-string of monofilament large suture (PDS 1). A re-usable trocar is inserted and accommodates a 30 degree angled scope. Specific tools are used in SILS, the grasper has two curves, the hook has one curve in order to permit ergonomic manipulation of the tools.

2. Insertion of triangulated instruments 01'00''

The double-curved grasper is inserted at a 45 degree angle and is placed just outside the purse-string, but inside the skin incision. The hook is inserted inside the purse-string, also at a 45 degree angle. Once inside the abdomen, the triangulation principles can be followed. The grasper is inserted in a special way at a 45 degree angle and the curve is followed while the tool is being introduced. Since the element is insufflated and the scope is in place, this can be done without any danger.

3. Exposure of appendix 01'45''

The caecum is pulled out of its pelvic position thanks to the specific grasper and the appendix is exposed. The Douglas’ pouch is emptied and rinsed, and the cautery hook is now introduced. The appendix is snapped and the meso-appendix is now severed using monopolar cautery. In our hands, this technique has been very safe and obviously very inexpensive. The surgeon is standing straight, the arms in slight abduction with the tools at a 90 degree angle, with the scope at a bisector between the two.

4. Meso-appendix dissection 02'43''

The meso-appendix is completely separated from the appendix until the caecum is reached.

5. Appendix tying 03'04''

As per routine, the appendix is now tied using a pre-formed slipknot, which is placed just at the caecal edge.

6. Introduction of curved scissors 03'33''

A curved scissors is now introduced, again following the same principle: introduction at a 45 degree angle and gentle manipulation until the curve has been placed well inside the abdomen. The specific shape of the instruments allows to do the manipulation without jamming the instruments. The second loop is now placed, just distal to the first one, and the scissors are again introduced and used to cut both the stitch and the appendix in between the two ligations. So as to not contaminate the incision, the appendix is placed in a simple plastic bag and pulled through the incision in a sterile fashion.

7. Final incision 04'52''

The final incision appears to be 16mm.