title: Two-port vs. three-port laparoscopic appendicectomy: A bridge to least invasive surgery.
abstract: BACKGROUND
  The conventional three-port technique for laparoscopic appendicectomy has proven its worth in the management of appendicular pathologies. From a cosmetic viewpoint, the umbilical and suprapubic port-sites are hidden by natural camouflages, the right Iliac fossa (RIF) port is the only visible external sign of surgery. The two-port technique avoids even this marker of abdominal invasion. In this study, we describe the technique of two-port laparoscopic appendicectomy (TPA) and compare it with conventional laparoscopic appendicectomy (CLA).
  
  
  METHODS
  All patients studied underwent operation for acute appendicitis during a 6-month period. Data were collected prospectively for the TPA and retrospectively for the CLA. The TPA was performed with one 10 mm umbilical working port and one 5 mm suprapubic camera port. A hypodermic needle was introduced in the RIF to retract the appendix. The appendicular artery was controlled with diathermy or ultrasonic shears. The base was ligated with a loop knotted extracorporeally. CLA was performed via the conventional 10 mm umbilical, 5 mm suprapubic and 5 mm RIF ports. The appendicular stump was ligated with an endoloop or an intracorporeal knot.
  
  
  RESULTS
  A total of 146 patients underwent surgery over the 6-month period for appendicitis. Out of 62 cases attempted, the TPA was successful in 51 cases, with conversion to the three-port technique in 11. The operative time, complication rates, return to work were comparable between the two groups. Patients who had TPA had a shorter postoperative stay.
  
  
  CONCLUSIONS
  This is an initial experience with TPA. There is little difference in the operative time, postoperative stay and complications rates between this technique and the conventional three-port one. There is hence little to be lost and a likely benefit to be gained by performing the TPA although a randomised study is necessary.
authors.affiliation: Department of General Surgery, Apollo Hospitals, Chennai, Tamil Nadu, India.
authors.forename: Ashwin
authors.initials: A
authors.lastname: Rammohan
authors.forename: Paramaguru
authors.initials: P
authors.lastname: Jothishankar
authors.forename: A B
authors.initials: AB
authors.lastname: Manimaran
authors.forename: R M
authors.initials: RM
authors.lastname: Naidu