An Emerging Surgical Strategy for Acute Appendicitis

Appendectomy is one of the more common surgical procedures that is performed throughout the United States each year despite decreasing in annual incidence. Open and laparoscopic appendectomy procedures are current standard treatments for non-complicated appendicitis, but advances in surgical techniques are continuing to emerge to further reduce postoperative pain and recovery time. One such procedure is natural orifice transluminal endoscopic surgery (NOTES) for performing transgastric appendectomy. Transvaginal surgery is one component of NOTES that is gaining momentum for use in appendectomy and cholecystectomy. Transvaginal appendectomy (TVA) is a procedure performed via a single port that is inserted through the posterior vaginal fornix. The surgery is a type of NOTES that allows for appendectomy without visible scars. “NOTES has been at the forefront of minimally invasive surgery since it first emerged in 2004,” says Kurt E. Roberts, MD. “Some studies have described laparoscopic assisted TVAs for acute appendicitis in the surgical literature. However, pure TVAs have been limited to only one single-case report in Germany.” Data on the Safety & Efficacy of TVA Exploring the safety and efficacy of pure TVAs and comparing them with traditional laparoscopic appendectomy are important, according to Dr. Roberts. In the February 2012 Annals of Surgery, he and his colleagues published a study that compared a series of patients who underwent TVA with those who received conventional three-port laparoscopic appendectomy. TVA was offered to 42 women, 18 of whom agreed to undergo the surgery while two others declined it. The remaining 22 women were considered the control group, receiving three-port laparoscopic appendectomy. Patients in the TVA arm required significantly less pain medication and returned to...