Laparoscope-assisted appendectomy in children: The two-trocar technique

The conventional cannulae position in laparoscopic appendectomy does not permit good visualization of the appendix, especially if it is in a retrocaecal or pelvic position. In children, the smaller dimension of the peritoneal cavity aggravates this problem. Method: In order to optimize appendix visualization; we propose a modification of the cannulae position associated with extraabdominal appendectomy. Two trocars are inserted, one in the umbilicus under direct vision and one in the midline above the pubic symphysis. The telescope is inserted in the second cannula. The appendix is delivered via the umbilical trocar incision and a conventional appendectomy is performed. Results: During a one-year period, 38 appendectomies were performed. In 29 cases (76.3%) the technique was successful. In 9 patients (4 with peritonitis, 4 with a retrocaecal and one with a pelvic appendix) a third trocar was necessary to complete the operation. We had two conversions (5.2%), one to open surgery and one to intraabdominal laparoscopic appendectomy. Mean operation time was 19 min. There were two infectious complications (one parietal and one intraabdominal). Conclusions: The excellent visualization permitted considerable time gain. Infectious complications were also low. This method is suggested as an alternative procedure for appendectomy, especially in children, because of their favorable anatomy.