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WJOLS

Clinical Experiences of Trans-Trocar Appendix Removal in Laparoscopic Appendectomy
In both groups, readmission were developed in cholecystectomy. So, there is not adequate for variable
each one person. Each person in TTAR and DSVB were laparoscopic surgery. 11,12 Therefore, there are several
admitted due to recurrent right quardrant pain without effort to renovation of specimen vinyl bag or minimize
intra­abdominal abscess in abdominal ultrasonography to cost of commercial specimen vinyl bag. 4-7,10,11
or abdominal computed tomography and treated con­ Trans­trocar appendix removal method in laparo ­
servatively for few days. s copic appendectomy was showed by several investigators
6-8
instead of disposable specimen vinyl bag. But clinical
diSCuSSion experiences and outcome were not reported in literature.
Trans­trocar appendix removal method may be more
The advantages of laparoscopic surgery are minimal risky that there are bacterial contamination in abdominal
wound, better cosmesis, less pain and quicker recovery. cavity and tumor cell spillage from resected appendix
Because of these advantages, laparoscopic surgery is very than using disposable specimen vinyl bag. But, actually,
popular method in most of surgery. In laparoscopic sur­ there has not been studied risk of trans­trocar removal
gery, there are needed variable laparoscopic instrument. method about bacterial contamination and tumor cell
These laparoscopic instruments are almost disposable spillage.
and expensive. Therefore, variable methods were showed Recently, the study about trans­trocar appendix remo­
by many clinicians to decrease to use disposable instru­ val is reported. Jung and Bae said that adequate trocar
ment. 6,10,11 size of trans­trocar appendix removal in laparoscopic
Disposable specimen vinyl bag have several advan­ appendectomy was determined according to preopera­
tages. These are minimal contamination of the abdominal tive patient’s BMI. 13
cavity or wound tract when removing the specimen and In the Jung and Bae’s study, when postoperative
prevention of tumor cell spillage from resected specimen. trans­trocar appendix removal test in 15 mm trocar was
But commercial specimen vinyl bag is expensive and limi­ performed, predictive success rate was 88% in all patients.
ted size and design based on gallbladder in laparoscopic According to BMI, predictive success rate is 100% in
2
patients below 20 kg/m , 94% in patients between 20 kg/m 2
Table 1: Patient demographics and 25 kg/m and 61% above 25 kg/m In our study,
2
2
TTAR DSVB success rate of 15 mm trans-trocar appendix removal is
(n = 59) (n = 60) p-value 89.3% in all patients. In 59 patients of 66 patients, trans-
13
Age (year) 42.5 ± 35.5 47.0 ± 34.0 NS trocar appendix removal was successfully performed. And
Gender (male/female) 28/31 40/20 NS according to BMI, success rate is 100% below 20 kg/m ,
2
2
Body mass index (kg/m ) 23.8 ± 8.1 27.6 ± 5.1 NS 87.8% in patients between 20 kg/m and 25 kg/m and
2
2
NS: nonspecific
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61% above 25 kg/m (Table 3).
Table 2: Postoperative clinical data Although, it is difficult to generalize the result of this
TTAR DSVB study, it is thought to be technically feasible to perform
(n = 59) (n = 60) p-value trans-trocar appendix removal in BMI < 25. But, in BMI
Operation time (min) 117.5 ± 82.5 102.5 ± 57.5 NS > 25, it is thought to be technically careful to perform
Hospital stay (day) 4.0 ± 2.0 4.5 ± 2.5 NS trans­trocar appendix removal.
Incisional site infection 3 2 NS In our study, the patients that had perforation, abscess
Intra-abdominal abscess 0 0 NS formation and coexistence of appendiceal tumor were
Additional analgesics use 10 12 NS excluded, so that prevent to bacterial contamination and
Readmission within 1 1 NS
30 days spillage of tumor cell. Therefore, surgical site infection
NS: nonspecific rate was not significant in both groups.
This study is retrospective but, there are no selec­
Table 3: Review of the literature for trans-trocar appendix tion bias by physician and no patient selection criteria
removal in laparoscopic appendectomy
between trans­trocar removal and specimen vinyl bag
Our results group. Therefore, there are no significant differences to
Predictive success rate Success/fail Success
in Jung and Bae (n = 62) (n = 66) rate (%) age, gender and BMI between trans-trocar removal and
Total patients 88.7 59/7 89.3 specimen vinyl bag group. Furthermore, in operation
2
BMI (kg/m ) time and hospital stay, there are no significant differ­
< 20 100 19/0 100 ences too.
20 ~ 25 94.3 29/4 87.8 There are possibility of more wound pain and larger
25< 61.5 11/3 78.5 scar in 15 mm trocar inserted patients than 11 mm trocar
World Journal of Laparoscopic Surgery, September-December 2014;7(3):107-110 109