Transumbilical Laparoscopic-Assisted Appendectomy: An Extracorporeal Single-Incision Alternative to Conventional Laparoscopic Techniques

Abstract

Recently the use of a single umbilical incision to perform an appendectomy has been described. The purpose of this study was to review our initial experience with transumbilical laparoscopic-assisted appendectomy (TULAA) in the pediatric population. A retrospective review of all pediatric patients treated for appendicitis over a 10-month period was performed. The surgical technique involved using a standard 3-mm or 5-mm trocar for visualization and insufflation. A dissecting/grasping instrument was used adjacent to the trocar through the same incision. Patient demographics, operative findings and time as well as postoperative course were reviewed. Of 21 patients undergoing laparoscopy appendectomy, 18 patients successfully underwent TULAA. Five patients had advanced appendicitis, four had a retrocecal appendix, and three had appendicoliths. The average total operative time was 51 ± 15 minutes. Overall, the average length of stay was 1.2 ± 0.8 days; however, all patients with nonperforated appendicitis were discharged the day after surgery. All patients were followed postoperatively, and none reported postoperative complications of abscess or wound infection. Cost analysis demonstrated a markedly reduced associated cost for TULAA compared with conventional laparoscopy. TULAA is a safe and effective single-incision approach for early appendicitis that incorporates both open and laparoscopic techniques to provide excellent exploration of the abdomen, a short hospital stay, minimal pain, and an excellent cosmetic result. The technique described is cost-effective, because it does not use any special laparoscopes, trocars, or staplers. When performed as described in this study, only a single trocar and a standard laparoscopic setup are required. Cases of advanced appendicitis may require additional trocars or "conversion" to conventional laparoscopic techniques.