Single port appendectomy using the EK glove port: a cost-effective innovation

Single port laparoscopic surgery has emerged to enhance the cosmetic benefits and to decrease morbidity in minimally invasive surgery. However, this technique requires a specialized multichannel port (to introduce the laparoscope and instruments) which is very costly and not affordable for the majority of the population. We have improvised a single port access system using readily available materials like surgical gloves, the rigid plastic ring, the inner flexible ring and conventional laparoscopic trocars (the EK Port) with no added cost for the patient. This also eliminates the need for an Alexis® wound retractor. We have performed about 130 single port surgeries since September 2009 using this technique without any complications.

Create account

Browse the WORLD

Virtual University

Google translate

Summary
Chapters
Your comments
Ask the Experts

You need to log in to watch this media!

Click here to log in.

Single port appendectomy using the EK glove port: a cost-effective innovation

Authors

E Khiangte, I Newme

Abstract

Single port laparoscopic surgery has emerged to enhance the cosmetic benefits and to decrease morbidity in minimally invasive surgery. However, this technique requires a specialized multichannel port (to introduce the laparoscope and instruments) which is very costly and not affordable for the majority of the population. We have improvised a single port access system using readily available materials like surgical gloves, the rigid plastic ring, the inner flexible ring and conventional laparoscopic trocars (the EK Port) with no added cost for the patient. This also eliminates the need for an Alexis® wound retractor. We have performed about 130 single port surgeries since September 2009 using this technique without any complications.

Classification

single port, contribution

Keywords

Single port appendectomy, EK glove port

Media type

Surgical video

Duration

04'53''

Publication

2011-10

Popular

Favorites

Favorites Media

Audio

Subtitles

E-publication

WeBSurg.com, Oct 2011;11(10).
URL: http://www.websurg.com/doi-vd01en3399.htm

Single port appendectomy using the EK glove port: a cost-effective innovation

1. Introduction 00'08''

This video demonstrates a cost-effective single port access system innovated by Dr. Elbert Khiangte.

2. Materials required to prepare the EK glove port 00'19''

To prepare this port, we require conventional 10mm and 5mm trocars, a pair of surgical gloves, an outer rigid ring, and an inner flexible ring. A prolene thread is attached to the inner ring for easy retrieval after the end of the surgery.

3. Preparing the rubber bands 00'35''

One of the fingers of the glove is cut. This allows to obtain thin slices that can be used as rubber bands.

4. Fixing the trocars 00'50''

A nick is made in the fingers of the other glove. The trocars are inserted into it and fixed with the rubber bands that were made earlier. A variety of trocars such as 10mm, 5mm and 3mm trocars can be used, depending on the surgery. For appendectomy, we require a 10mm trocar for the telescope and two 5mm trocars for the hand instruments. A total of five instruments can be deployed through this port if required. This port is prepared using the readily available materials. It is cheap and easily reproducible with no added financial burden to the patient.

5. Construction of the EK Port 01'32''

The open end of the glove is passed through the inner flexible ring and it is then turned over it, thus allowing the flexible ring to be in-between the two layers of the glove. This is the EK glove port ready for use.

6. Skin marking and incision 01'53''

Markings are made in the umbilicus so that we do not extend the incision beyond it. A curvilinear incision of about 2 to 2.5cm is made in the umbilicus, and the subcutaneous tissues are dissected up to the rectus sheet. A rectus fasciotomy is performed in order to enter the peritoneal cavity. All necessary precautions are taken to make sure that the incision is within the depth of the umbilicus.

7. Insertion of the rings 02'27''

The inner ring with the glove is then inserted through the wound of the umbilicus using a retractor and fingers. The outer rigid ring is placed over the glove and the open end of the glove is then wrapped around the outer rigid ring.

8. Insufflation 02'56''

The carbon dioxide gas insufflator is now assembled to insufflate the abdomen. The telescope is introduced into the abdomen.

9. Inside view of the port 03'12''

This view shows the opening in the umbilicus. We are now inside the abdomen.

10. Appendectomy 03'23''

This is an acute appendicitis. The appendix is lying in the pelvis, which is covered with the omentum.

11. Adhesiolysis 03'32''

The adhesiolysis is performed using the ultrasonic scalpel. The operative field is carefully examined.

12. Dissection of the appendix 03'53''

The meso-appendix is then divided cautiously by means of the ultrasonic scalpel. Care should be taken while introducing the sharp instruments to prevent the glove from puncturing.

13. Ligation of the appendix 04'18''

The base of the appendix is then ligated twice using a No.1 absorbable suture. The extracorporeal Meltzer’s knot is used for that purpose.

14. Division and extraction of the appendix 04'36''

The appendix is then crushed using the grasper and divided by means of a pair of scissors. The appendix is now extracted out of the abdomen through the port.

15. Peritoneal wash 04'48''

The peritoneal cavity is washed using normal saline. The omentum is brought over the appendicular stump.