IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 14, Issue 3 Ver. VIII (Mar. 2015), PP 21-24 www.iosrjournals.org DOI: 10.9790/0853-14382124 www.iosrjournals.org 21 | Page Needle Port Assisted Two-Port Laparoscopic Appendicectomy Kiran Kumar KM 1 , Naveen Kumar M 2 , Srinivas Arava 3 , Kishore Krishna 4 , Pratheek KC 5, Dept. of Surgery, Sree Siddartha Medical College, Tumkur, Karnataka, India 1,3 Professor, 2 Assistant Professor, 4,5 Junior resident. Address for Correspondence : Dr. Kiran Kumar KM, 109, “Khushi”, 6 th main road, Ashoka Nagara, Tumkur 572102. Mob: 9886609009, Abstract: Introduction: In conventional Laparoscopic Appendicectomy, three ports are used wherein both the sub- umbilical and supra-pubic port sites are hidden the by the natural camouflages and the only visible scar is the third port in the iliac fossa. The third port scar can be made invisible by using a needle port for trans-parietal appendicular traction. Materials and Methods: From January 2013 to May 2014 we attempted 35 cases of Needle port assisted Two port Laparoscopic Appendicectomy of which 7 were converted to conventional three port technnique. After introducing 10 mm subumbilical telescopic port and a 5 mm suprapubic working port, an 18G needle fastned with prolene was made into a loop and introduced in right iliac fossa to retract the appendix as the third port, which scarless. Results: Of the 35 included 7 were converted to conventional laparoscopy. Except for wound infection in 3 cases of appendicular abscess, post-operative complications were nil. Mean operative time was 55 minutes. Conclusion: Needle port assisted two port laparoscopic appendicectomy has all the merits of conventional laparoscopy with additional advantage of invisible scars. Keywords: Laparoscopic appendicectomy, two port laparoscopic appendicectomy, I. Introduction Laparoscopic Appendicectomy (LA) has the advantages of less pain, fewer post-operative complications, shorter hospitalization, earlier return to work and better cosmesis 1,2,3 requiring three ports. These three ports can be avoided in Single Incision Laparoscopic Surgery (SILS) with special multiport umbilical trocar and specialized instruments, but has a steep learning curve due to loss of triangulation, clashing of instruments, lack of maneuverability, decreased technical expertise among the surgeons and an added financial burden to the patients. Thus, limiting its widespread use especially in rural/peripheral centers with limited resource. 4,5 . Recent development is Natural Orifice Trans-luminal Endoscopic Surgery (NOTES) but, there are numerous difficulties including, complications of opening hollow viscera, failed sutures, lack of fully developed instrumentation and necessity of reliable cost-benefit analyses 6,7 . In conventional three-port LA (CLA) from a cosmetic viewpoint, the sub-umbilical and supra-pubic port sites are hidden by natural camouflages, but scar of the third port in the iliac fossa is the only visible external sign of surgery. In Needle-port assisted two-port LA (NLA) we avoid the third Laparoscopic port, instead an 18G hypodermic needle fastned with a poly-propelene (prolene) 1-0 suture material which we call as “Needle loop retractor” (NLR) is introduced in the right iliac fossa for retraction on the appendix 8 . This technique is virtually scar-less as the third port is needle port which does not produce a scar at all. This technique replicates the intra peritoneal view and operative technique of CLA, hence has a very short learning curve. Compared to SILS and NOTES, there is no need for expensive specialized equipment. NLA can be considered as the best procedure for selective cases of AA 9 . II. Materials And Methods Patients with Appendicitis were confirmed sonlogically and included. Patients with perforation- peritonitis and shock were excluded. A detailed proforma was recorded, and laboratory blood investigations done. Ethical clearance and Informed consent was obtained. Possibility of conversion to CLA or even open Appedicectomy if necessary was explained to patients. Procedure Patients were made to empty their bladders before lying on the operation table. Under General Anaesthesia, pneumoperitoneum of 12 mm Hg wascreated. With10 mm sub-umbilical camera port a diagnostic laparoscopy was done and another 5 mm supra-pubic working port introduced. Table positioned with head low and tilt to left side. This facilitates evaluation and mobilisation appendix with a grasper. Appendix was held in