Comparison of Various Methods of Mesoappendix Dissection in Laparoscopic Appendectomy

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Although laparoscopic appendectomy is one of the most commonly performed operations, operation procedures vary widely according to the surgeon. In particular, various methods using different instruments have been used for mesoappendix dissection, such as endostapler, endoclip (EC), Harmonic(®) (Ethicon Endo-Surgery, Cincinnati, OH) scalpel (HS), electrocautery, and LigaSure™ (Covidien, Mansfield, MA). Here we compared the results of mesoappendix dissection by EC, HS, and monopolar electrocautery (ME). The study was performed on 1178 patients who received laparoscopic appendectomy at the Armed Forces Capital Hospital, Seongnam, Korea, from January 2003 to April 2013. Patients receiving mesoappendix dissection involving EC, HS, or ME were enrolled. Patient demographics, pathology of appendix, and perioperative data including operation time, hospital stay, and complications were analyzed. A theoretical model of disposable cost was constructed for each method to compare cost-effectiveness. The average operation time for the 1178 patients was 58.0±24.9 minutes for the EC group, 51.4±25.5 minutes for the HS group, and 57.7±25.7 minutes for the ME group. The time for the HS group was significantly shorter. Hospital stay and complication rates did not differ. Disposable costs were 620,350 South Korean won (KRW) (571 U.S. dollars) for the EC group, 1,041,230 KRW (959 U.S. dollars) for the HS group, and 491,230 KRW (452 U.S. dollars) for the ME group. The operation time of ME was similar to that of EC. Although HS had a significantly shorter operation time, the operation time of all three methods was under 60 minutes. All three methods had acceptable complication rates. ME was the most cost-effective method and, given the other similarities, can be recommended for mesoappendix dissection in laparoscopic appendectomy.