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Disposable free three port laparoscopic appendectomy – low cost alternative for emergency 

Gastroenterology & Hepatology: Open Access
Carlos Eduardo Domene, Paula Volpe, Frederico Almeida Heitor, André Valente Santana,

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Rationale: Video laparoscopic appendectomy does not have a single protocol on technical systematization, access routes, energy use, and staplers. The cost of disposable materials may prevent its widespread use. Alternatives to lower the cost can help disseminate laparoscopic access in appendectomy. 
Objective: This study aimed to introduce a method in performing video laparoscopic appendectomy at low cost and aiming at a good aesthetic result through the location of its incisions and show its viability through its application in 1552 cases of video laparoscopic appendectomy performed between 2000 and 2019 with three portals, with extremely low cost in inputs used. 
Methods: Three punctures were performed – one umbilical puncture to introduce the camera (5 or 10mm in diameter), one 10mm puncture in the right iliac fossa, and one 5-mm puncture in the left iliac fossa. The last two punctures were performed medially to the epigastric vessels, which can be visualized with the aid of the laparoscopic camera externally, by transparency, or internally, under direct vision. The materials– trocars, grasping forceps, hooks, scissors, and needle holders, are of permanent use, without the need for any disposable material. 
Results: A total of 1552 patients underwent operation between 2000 and 2019; 56.25% were female, the mean age was 32.66years (9–93years), and the mean and median lengths of hospital stay were 1.74days (1–10days) and 1.2days, respectively. 
Conclusion: The described technique uses three metal trocars and four permanent instruments, in addition to a single cotton thread. The use of extraction bags for operating parts, clips, handles, staplers or special energy, and bipolar or harmonic instruments was discontinued. Therefore, it is a low-cost laparoscopic procedure. Because it allows triangulation and instrumentation in the conventional way, it is a safe and reproducible surgery, which can be easily taught and widely used in hospitals that provide conventional laparoscopic equipment. Its application in 1552 patients in a 20-year period has shown excellent results and low morbidity and may become routine with the preferred indication for video surgery in the treatment of acute appendicitis.


appendectomy, laparoscopy, acute appendicitis, low morbidity, laparotomy, appendectomies, abdominal cavity, relaparoscopy