How is laparoscopic appendectomy (1 hole) performed?

The article is expertly advised by Mr. Dr. Duong Xuan Loc - Gastroenterologist - General Surgery Department - Vinmec Da Nang International Hospital

Laparoscopic appendectomy with 1 hole has many advantages compared to traditional laparoscopic appendectomy methods. Patients reduce pain, recover quickly, length of hospital stay is reduced, especially the aesthetic factor is very high, the patient has almost no scars or very faint scars.

The appendix is ​​a small, narrow, several centimeters long, pouch-shaped piece of intestine that attaches to the cecum (first part of the large intestine). Appendicitis is an inflammation of the appendix, caused by a blockage in the lumen of the appendix. Common causes of obstruction are fecal stones, gallstones, appendiceal tumors, lymphoid tissue enlargement due to infection, parasites, etc. Obstruction increases the pressure in the lumen of the appendix and reduces blood flow to the appendix. appendix tissues, creating conditions for bacteria to grow, causing inflammation. If not treated in time, appendicitis can burst, bacteria are released into the abdomen, causing life-threatening complications such as peritoneal infection, blood infection, appendiceal abscess, ...
Appendicitis is a very common surgical disease. Once diagnosed, appendicitis requires surgery as soon as possible to prevent complications.

There are 2 types of surgery that are open appendectomy and laparoscopic appendectomy.
Open appendectomy is a traditional surgery, the surgeon will make a 9-10cm incision in the lower right abdomen, a few centimeters above the hip bone. Perform skin and muscle dissection to identify the appendix. After the appendix is ​​removed from the surrounding tissue, the doctor will look closely to make sure the infection is only localized to the removed tissue. A sterile solution can be used to wash or aspirate this tissue if necessary. If the tissue is normal, the doctor will close the incision. Laparoscopic appendectomy includes the classic laparoscopic appendectomy (with 3 holes), laparoscopic appendectomy with 2 holes and laparoscopic appendectomy with 1 hole. Compared with traditional open surgery, laparoscopic surgery has many advantages such as less invasive patient, fewer complications, faster recovery time, guaranteed aesthetic factor because there is no long surgical scar on the abdomen. Due to the outstanding advantages, laparoscopic appendectomy is now routinely performed in medical facilities, except for some special cases such as ruptured appendix, widespread infection or abscess. The patient required open surgery to remove the appendix and clear the abdominal cavity.

2.1 Comparison of classic laparoscopic appendectomy and laparoscopic single-hole appendectomy With classical laparoscopic appendectomy, there will be 3 openings into the abdomen, one in the navel, one in the right iliac fossa and one in the right iliac fossa. in the left iliac fossa. One trocar will house the camera, the other two will contain instruments inserted into the openings in the abdomen. The doctor then looks at the video captured by the camera, identifies the appendix, separates the appendix from the surrounding tissue, and removes it. Use sterile fluid to wash the infected area, aspirate infected tissue if necessary.
With a single-hole laparoscopic appendectomy, the doctor only makes an opening on the abdomen at the navel position, the incision is about 3cm small. The advantage of this method is that it is less invasive, highly aesthetic due to only one hole in the abdomen, the incision does not leave scars or very faint scars. Patients have less pain, quick recovery, hospital stay is only 1⁄2 compared to laparoscopic appendectomy with 2 holes and 3 holes.
However, laparoscopic appendectomy with 1 hole is a difficult technique, requiring the surgeon to have expertise, experience and absolute precision. Because there is only one hole, the operation will be much more difficult than conventional laparoscopic surgery, the instruments are clustered in one place, which may collide with each other. Laparoscopic appendectomy with 1 hole is only applied in surgery for acute appendicitis, the appendix has not been ruptured and caused complications.

2.2 Steps to perform laparoscopic appendectomy 1 hole Laparoscopic appendectomy 1 hole is performed as follows:
The patient is under endotracheal anesthesia, lying on the operating table, supine position, head low , tilted left. The primary surgeon places a trocar for all three including the laparoscope and two instruments. Inflate the abdomen to create a pressure of 10-12 mmHg. Conduct abdominal examination, evaluate the peritoneum, damage to organs through images obtained from the camera. Dissection revealed the appendix and the mesentery to the base. Resection of the mesenteric appendix and hemostasis, tied the appendix stump with thread or clip, cut the appendix from the cecum. Clean the right iliac fossa and Douglas with physiological saline. Close the trocar position on the abdominal wall. After surgery, the patient will be given pain medication, monitored to detect and treat infection early. Patients can eat if bowel movements are normal. If there are no infectious complications, the patient can be discharged early.

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