Preliminary Experience of Glove Single Port Laparoscopic Appendectomy in Children and Adolescents for Uncomplicated Appendicitis

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ACTA SCIENTIFIC PAEDIATRICS (ISSN: 2581-883X)
Volume 3 Issue 3 March 2020
Preliminary Experience of Glove Single Port Laparoscopic Appendectomy in
Children and Adolescents for Uncomplicated Appendicitis
Yasser Ashour Mohamed1, Mohamed Ahmed Negm2*, Ibrahim Ahmed
Gamaan1, Sayed Ahmed Elhady1 and Mohamed Mohamed Shahin1
1Department of Pediatric Surgery, Al-Azhar University, Cairo, Egypt
2Pediatric Surgery Unit, Qena Faculty of Medicine, South Valley University, Qena,
Egypt
*Corresponding Author: Mohamed Ahmed Negm, M.D, Pediatric Surgery Unit,
Qena Faculty of Medicine, South Valley University, Qena, Egypt.
E-mail: drmohamednegm@yahoo.com
 drmohamednegm@med.svu.edu.eg
Research Article
 January 07, 2020;
Published: February 20, 2020
© All rights are reserved by Mohamed
Ahmed Negm., et al.

Keywords: Glove Single Port; Endoscopic Appendectomy; Children; Laparoscopy; One Port Endosurgery
AAP: Acute Appendicitis; CLA: Conventional Laparoscopic Appen-
dectomy; FPR: Flexible Plastic Ring; LAP: Laparoscopic Appendec-
tomy GSPLA: Glove Single Port Laparoscopic Appendectomy; ROR:
Rigid Outer Ring; SILAP: Single Incision Laparoscopic Appendec-
tomy; SILS: Single Incision Laparoscopic Surgery; SILT: Single Inci-
sion Laparoscopic Trocar.

: Laparoscopic appendectomy has been widely applied and became popular procedure for the surgical management of
  
surgery [SILS]. By this approach the laparoscopic instruments introduced to the abdomen through a longitudinal one umbilical inci-
sion only.
Purpose: This study aimed to present two centres initial experiences using home-made glove single port for laparoscopic appendec-
tomy [GSPLA] in children and adolescents.
Patients and Methods: This prospective study was conducted on patients of pediatric age with uncomplicated appendicitis using

folded glove was inserted into the abdominal cavity using a curved artery forceps. The open end of the glove was passed through the


Results: Seventy-two children with acute uncomplicated appendicitis were surgically treated by GSPLA. Their mean age was 13 ± 2.8



of follow up.
:     

Appendectomy is a well-established surgical procedure for the
treatment of appendicitis. The operation can be performed as an
open surgery or by laparoscopy. A further development in the min-
imally invasive appendectomy technique has been the introduction
[1,2].

    
best surgical choice for the treatment of appendicitis [3-5].
-
ric age. But it is still not a well-established technique and not widely
practiced because it is ergonomically challenging when compared
with multi-port laparoscopic procedure. Moreover, SILT access de-
creases the range of movement for the surgeon and assistant with
 The commercially available SILT in addi-
tion to its high cost needs special instruments with limited range of
movements especially when performed in children [9].
ORCID ID: 
DOI:
Citation: Mohamed Ahmed Negm., et al. “Preliminary Experience of Glove Single Port Laparoscopic Appendectomy in Children and Adolescents for
Uncomplicated Appendicitis”. Acta Scientific Paediatrics

This prospective study included all children and adolescents
with non-complicated appendicitis. The study was done in two pe-
diatric surgery centres of Al-Azhar, Qena University Hospitals and

2019. All children were subjected to laparoscopic appendectomy
with GSPLA technique.
Pelvi-abdominal ultrasound was done by a senior radiologist
for all patients.
Patients and Methods
This study aimed to present the outcome of initial experience
of SILAP using a home-made surgical glove for uncomplicated ap-
pendicitis in children and adolescents.
The study was approved for clinical study by Ethical Research
Committee. Before enrolment of the patients in this study, the par-
ents were agreed and signed a written consent.

    -
nal U/S, CBC, CRP and urine analysis were carried out. Antibiotic



General with endotracheal intubation.

Anaesthesia
Patient position: Supine with little tilting of the table to the left

the umbilicus was cleaned thoroughly with alcohol swabs and Po-
vidone Iodine solution which was applied also from the nipple to
the mid-thigh.
The home-made surgical glove single port was prepared from
            
   
glove was passed through the inner FPR and the open end turned
around it in the middle of the glove so to become inside the out
-

incision of about two cm was done and deepened to include the fas-

corners of the fascia and peritoneum for traction during insertion


Insertion of the well lubricated inner FPR to the peritoneal cav-
ity by using a curved artery forceps. The open end of the glove was
passed through the outer ROR where it was stretched and turned
several times around the ROR for tightening over the anterior ab-

Figure 1: Materials and instruments used for construction of
Home-Made Glove Single Port.


Figure 2: Steps of longitudinal umbilical incision and insertion of

Figure 3: Insertion of home-made glove single port through
umbilical incision.






57

Citation: Mohamed Ahmed Negm., et al. “Preliminary Experience of Glove Single Port Laparoscopic Appendectomy in Children and Adolescents for
Uncomplicated Appendicitis”. Acta Scientific Paediatrics


piece of elastic rubber band from the tips of other glove to prevent

-
tional laparoscopic instruments [3-mm or 5-mm] were introduced

  -
sure gradient from 8 – 12 mmHg according to child’s age, the peri-
-
    
exclude complicated appendicitis. The monopolar diathermy was
used in heat coagulation of meso-appendix and in some cases Har-
monic Scalpel was used. The base of the appendix was tied using
          
glove was used to exteriorise the appendix. Lastly closure of um-
        

Figure 4: 


Figure 5: Intraoperative view of acute appendicitis
Figure 6: Immediate post- operative photo of umbilical wound
       
described, and NSAID for analgesia. All children were allowed to
        
and the diet was advanced gradually as tolerated. Patients were
discharged home when tolerating a regular diet, usually at the
morning of the second post-operative day. However, some patients
were discharged home in the evening of the operative day. For

-
wvwLv-w-0jrd0



Follow-up
 -
 
   -
tive data were expressed as frequency and percentage.

Results
Seventy-two children with AAP were included in this study. The
demographic data of the patients is shown in Table 1. The appen-
      

-

GSPLA technique. Harmonic Scalpel was used to control the me-
    
cases. The base of the appendix was controlled by extracorporeal
         -


         
that improved conservatively. No other abdominal complications
reported in this study. The mean postoperative hospital stay was


call only. No umbilical infection or hernia developed in the follow-

58

Citation: Mohamed Ahmed Negm., et al. “Preliminary Experience of Glove Single Port Laparoscopic Appendectomy in Children and Adolescents for
Uncomplicated Appendicitis”. Acta Scientific Paediatrics

e
No. of patients  
Sex
Male
Female
50
22


Mean age in years
Range in years


Convertion to CLAP 2 
Mean operative time in minutes
Range

35 - 79
Accessability of the appendix
Accessable





Post-operative complications
Ileus 2 
Mean hospital stay in hours
Range in hours

35 - 72
Table 1: Showing patients’ demography and
the result of the study.
   
 
laparoscopy was Kurt Semm in 1983 [10,11]. Conventional laparo-
-
ment of complicated and uncomplicated appendicitis [3-5].

less postoperative pain and low doses of analgesics. It enables ear-

can return early to normal activities and also have fewer cosmetic
problems after surgery. For these reasons, CLA is one of the most
frequently performed emergency operations [12]. According to
what documented in the literature by many authors, the procedure
 
one procedure by the same approach, good patient compliance re-
garding post-operative pain and possibility for conversion to the
classic multiport laparoscopic procedure [13-15].
In a recent study by Martynov and Lacher, they documented

curved laparoscopic instruments but, it is costly if compared with
glove single port used in the current study and in country with low
available resources [9]. This also agreed with Lee., et al. in their
study using the same procedure with conventional laparoscopic
instruments with low cost .
In a randomized controlled trial done by Lee., et al. comparing
SILT with CLA they have documented that postoperative results
were similar. However, the increased costs for SILT compared to
CLA, especially when carried out by costly curved instruments is
a limitation of SILT technique. However, the technique used in this
study became popular and used by many authors. This may be due

to its low costs and, the use of conventional laparoscopic equip-
ment. Moreover, surgical glove port has been adopted for several
minimal procedures, including cholecystectomies and appendecto-
mies [8,17-20].
Martynov and Lacher [9] stated that the surgical equipments
needed to perform SILT in children are very expensive and they
added that the use of surgical glove port is not only cheap but al-
lows a wide range of movement of the instruments without colli-
 
of surgery between SILT using conventional laparoscopic equip-
ments compared with CLA [21].
In this study, the mean operative time of GSPLA procedure was
     
   

team to get familiar with the technique. Then, the operative time
was deceased gradually in the following cases.
Also, using the home-made surgical glove as a single port for the

to use and can be simply introduced into the abdominal cavity even
in obese children. It permits the laparoscopic instruments to be
passed through small incision. In addition, the glove acts as a barri-
er preventing the contact of the appendix to abdominal wall during
retrieval of the appendix with no need for laparoscopic endobag
especially low resource countries. The umbilical incision is small;
this minimizes postoperative pain and the rate of development of
infection or umbilical hernia due to the barrier effect of the glove.
           
   -
       
The elasticity of the surgical glove single port permits a good range
of movements of the instruments with enough triangulation with
       
small cut was made in the tip of the gloves port without using a
trocar and tied with a previously prepared elastic strip .
According to the present study, the GSPLA technique has been
shown to be not only feasible but also safe and effective, with a
  -
era man is very important to carry out the technique smoothly and

another problem that may slow the procedure as there is no sepa-
rate venting channel in cases of GSPLA.
In the current study, all cases were completed laparoscopical-
         -
sinating instrument [3 with multiple adhesions and 2 with retro-
cecal position of the appendix. No case needed conversion to open
59

Citation: Mohamed Ahmed Negm., et al. “Preliminary Experience of Glove Single Port Laparoscopic Appendectomy in Children and Adolescents for
Uncomplicated Appendicitis”. Acta Scientific Paediatrics

The glove single-port laparoscopic appendectomy is a new tech-
nique which is cheaper than the other SILT devices. According to
the results of this study, laparoscopic appendectomy in pediatric
age using the home-made glove single port is quite easy to be done
for non-complicated appendicitis with short learning curve. This
    
of laparoscopic instruments.

surgery and this agreed with Lee., et al. in their study comparing
home–made port with conventional laparoscopic procedure.
 et al. earlier stated that in their study, a higher


[22].
In this study, early mobilization was advised and the majority
of patients were usually discharged on the second post-operative
day. The mean postoperative hospital stay was ranged from 35 - 72

The clinical limitation of the present study is its application in
only non-complicated appendicitis and the small number of cases.
But this may be explained by our initial results with early learn-
ing curve to be familiar of this technique. Larger numbers together
with long term follow up of cases are needed to support the idea of
this technique in the future.

        
Professor of Pediatric Surgery and innovator of laparoscopic sur-
gery, Al-Azhar University, Cairo, Egypt for his encouragements and
support for mastering this technique and meticulous revision of
this article.

None.
Funding
None.

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

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 Oltmann, Sarah C., et al. “Single-incision laparoscopic surgery:
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American Surgeon; Atlanta

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Citation: Mohamed Ahmed Negm., et al. “Preliminary Experience of Glove Single Port Laparoscopic Appendectomy in Children and Adolescents for
Uncomplicated Appendicitis”. Acta Scientific Paediatrics