RETROSPECTIVE REVIEW ON GLOVE FINGER EXTRACTION TECHNIQUE IN LAPAROSCOPIC APPENDECTOMY
Vishal Chandel*1, Neel Chandel3, Imran Khokhar1, Sharique Nazir2
1Suburban Community Hospital, East Norriton, PA; 2NYU Langone Hospital Brooklyn, New York, NY; 3Roxborough Memorial Hospital, Philadelphia, PA
INTRODUCTION:
Acute appendicitis is one of the most common gastrointestinal surgical emergencies. We intend to present glove-finger extraction (GFX) using surgical glove as a safe alternative to Endocatch™ specimen bag during the extraction process during laparoscopic appendectomy. We seek to demonstrate the cost effectiveness, feasibility, implications for operative timing and post-operative complications using the surgical glove, one of the most readily available operating room commodities, for glove finger extraction.
METHODS:
128 patients with acute appendicitis, who underwent laparoscopic appendectomy in 3-year interval period at our institute were retrospectively reviewed. Out of them, 49 specimens were collected through the GFX technique. Outcome parameters noted were duration of the operation, postoperative complications (intra-abdominal abscess, wound infections, post-operative pain), length of hospital stay, and readmission rate.
RESULTS:
Out of 49 GFX appendectomies, one patient had a post-operative fever, another had abdominal pain; both were successfully treated with acetaminophen, yielding a complication rate of 4.1% (2/48). In endocatch group (EC), there were 6 complications for a complication rate of 7.6% (6/79). The OR (operating room) time for GFX and EC group was 51-58 minutes and 57-68 minutes respectively. The mean operating time of the GFX and EC group was 54.4±0.6 mins and 62.1±0.7 minutes respectively. On average, the GFX was shorter by 7.7 minutes (p = 0.009). There were no significant differences in length of stay (p=0.581).
DISCUSSION:
Our estimate showed $2.06 as cost of pair of sterile surgical gloves and $69 that of EC bag. There is a total of $66.94 saved using a GFX over the conventional EC bag. In high-volume procedures such as laparoscopic appendectomies, there is a greater need to emphasize cost reduction measures. Using a glove-sleeve in place of an endocatch bag retains the benefits of laparoscopic surgery, while mitigating costs, thus reducing the burden of higher costs in this procedure. Complication rates and length of stay had no significant difference between two groups, but the glove-sleeve method was quicker in operative time, compared to endocatch bag. The glove finger does not need special storage or deployment techniques and is commonly available among other surgical equipment, henceforth, there is less room for human error. More studies with multiple surgeons of varying skillsets and a larger sample size are needed to confirm these findings.
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