title: Two-port laparoscopic appendectomy as transition to laparoendoscopic single site surgery.
abstract: BACKGROUND
  According to the precepts of reduced surgical trauma and better cosmesis, an intermediate laparoscopic appendectomy technique between the conventional three-trocar procedure and Laparoendoscopic Single Site Surgery (LESS) was performed, based on literature review and experience of the surgical team.
  
  
  METHODS
  Patients with early stage acute appendicitis and a favourable anatomical presentation were selected. The procedure was performed with two ports: A 10 mm trocar at the umbilicus site for laparoscope and a 5 mm one just above the pubic bone for grasper. The appendix was secured by external wire traction through a right iliac fossa puncture with 14-gauge intravenous catheter.
  
  
  RESULTS
  From August 2009 to December 2012, we performed 42 cases; two required conversion to a conventional laparoscopic technique. There were no complications in the remaining, no wound infections and a mean operation time of 64.5 minutes.
  
  
  CONCLUSIONS
  The use of two-port laparoscopic appendectomy can act as a LESS intermediate step procedure, without loss of instrumental triangulation and maintenance of appropriate counter-traction. This technique can be used as an alternative to the three-port laparoscopic procedure in patients with initial presentation of appendicitis and a favourable anatomical position.
authors: Department of Surgery, Hospital Militar de Área de Porto Alegre, Rio Grande do Sul, Brazil ; Department of Surgery, Hospital de Clínicas, Federal University of Rio Grande do Sul State, Porto Alegre, Rio Grande do Sul, Brazil.
authors: José Gustavo
authors: JG
authors: Olijnyk
authors: Department of Surgery, Hospital Militar de Área de Porto Alegre, Rio Grande do Sul, Brazil ; Department of Surgery, Hospital de Clínicas, Federal University of Rio Grande do Sul State, Porto Alegre, Rio Grande do Sul, Brazil.
authors: Guilherme Gonçalves
authors: GG
authors: Pretto
authors: Department of Surgery, Hospital Militar de Área de Porto Alegre, Rio Grande do Sul, Brazil.
authors: Omero Pereira
authors: OP
authors: da Costa Filho
authors: Institute of Education and Research, Hospital Moinhos de Vento de Porto Alegre, Rio Grande do Sul, Brazil.
authors: Fernando Koboldt
authors: FK
authors: Machado
authors: Department of Surgery, Federal University of Amazonas State, Manaus, Amazonas, Brazil.
authors: Sidney Raimundo
authors: SR
authors: Silva Chalub
authors: Department of Surgery, Hospital de Clínicas, Federal University of Rio Grande do Sul State, Porto Alegre, Rio Grande do Sul, Brazil.
authors: Leandro Totti
authors: LT
authors: Cavazzola
keywords: Appendix fixation; LESS; laparoscopic appendectomy; minimally invasive surgery