Laparoscopic finger-assisted technique (fingeroscopy) for treatment of complicated appendicitis.

Laparoscopic appendectomy for acute appendicitis, first described by Semm in 1982, is still a procedure under evaluation: The small incision used in the open technique approximates the one required for the insertion of a laparoscopic port. Furthermore, published data have demonstrated conflicting results or have failed to establish laparoscopy as the technique of choice for the management of acute appendicitis. The laparoscopic management of perforated appendicitis is even more questionable. The technique is challenging because of the loss of tactile feeling and the difficulties in distinguishing healthy bowel from necrotic tissue. Conversion rates for attempted laparoscopic appendectomy in perforated appendicitis range from 6.5% to 17.6%, mainly because of excessive inflammation, presence of adhesions, or retrocecal position of the appendix. In fact, a preoperative diagnosis of perforated appendicitis is a contraindication to laparoscopy in most centers. Adequate exposure frequently requires a large open incision. We describe a finger-assisted technique, or “fingeroscopy,” as a simple add-on procedure that can be used during laparoscopic treatment of complicated appendicitis. This technique restores the surgeon’s tactile ability and allows gentle and safe blunt dissection of appendiceal masses under laparoscopic guidance. The technique is applied without enlarging the port incision and reduces the conversion rate to an open procedure.