The lasso technique' - a simple intracorporeal two-port laparoscopic appendectomy: technical considerations and review of four other intracorporeal two-port techniques.

BACKGROUND/AIMS To decrease surgical trauma and scar formation we present intracorporeal two-port procedure in selected patients. METHODOLOGY Supraumbilical 5mm port is used for the laparoscope. Suprapubic 12mm port is in the midline or left paramedian position below the underpants line. Pretied loop suture is tied around the base, 1-2 cm distally from the origin of the appendix, or below the macroscopically changed appendix. Endoclose is introduced 1-2 cm cranially from the location of appendiceal base and the endoloop is exteriorized and the appendix elevated. Harmonic scalpel is used for dissection and skeletonization and the appendix is divided with 45 mm linear cutting stapler. RESULTS Two-port appendectomy was attempted in 11 consecutive patients. In 3 patients operation was converted to open procedure and in 2 patients the third port was needed. Finally 6 (54%) patients were operated with the similar operating time (36-51 min) as standard three-port technique with the same postoperative pain and bowel function recovery. The postoperative stay ranged 2 - 4 days. There was one wound infection of 12-mm port. CONCLUSIONS This intracorporeal two-port appendectomy in selected patients does not prolong operation time and further improves the minimal invasiveness and contributes to excellent cosmetic results.