title: Transumbilical endoscopic appendectomy in humans: on the road to NOTES: a prospective study.
abstract: BACKGROUND
  Natural orifice translumenal endoscopic surgery (NOTES) is the newest technique emerging in the field of surgery. There are several techniques described in the literature, though there is no standardization yet. In this paper, we describe a transumbilical approach for the endoscopic appendectomy in humans.
  
  
  METHODS
  Eight of 12 patients with uncomplicated appendicitis successfully underwent a transumbilical endoscopic appendectomy. Patients with a mass, abscessed or perforated appendix, previous lower abdominal surgeries, and conversion to laparoscopy (4 patients) were excluded.
  
  
  RESULTS
  The average age of the patients was 32.5 years. The mean operating time was 95 minutes, and the conversion rate was 33.3%. Only 1 dose of intravenous analgesics was administered postoperatively. Hospital stay was 1-3 days. The follow-ups were scheduled at 7, 30, and 90 days and 8 months. Six patients completed all the follow-ups and experienced no problems.
  
  
  CONCLUSIONS
  So far, this transumbilical approach to the appendectomy in humans has not been reported. We think that this method of approach is an effective technique by itself and an ideal "stepping stone" to NOTES, as well as helpful to train laparoscopic surgeons to make the transition to full-fledged NOTES. Unlike the transgastric or transvaginal approaches, the umbilical approach allows an easy maneuverability of the endoscope, though at the cost of an umbilical scar. The technical ease of the procedure and early outcome seem satisfactory. This technique may be considered as a "precursor" to NOTES.
authors: Department of Minimal Access Surgery, GEM Hospital, Coimbatore, India. drcp@gemhospital.net
authors: Chinnusamy
authors: C
authors: Palanivelu
authors: Pidigu S
authors: PS
authors: Rajan
authors: Muthukumaran
authors: M
authors: Rangarajan
authors: Ramakrishnan
authors: R
authors: Parthasarathi
authors: Palanisamy
authors: P
authors: Senthilnathan
authors: Palanivelu
authors: P
authors: Praveenraj
mesh_terms: D000328:Adult; D000700:Analgesics / Q000008:administration & dosage; D001062:Appendectomy / Q000379:methods*; D001064:Appendicitis / Q000601:surgery; D004724:Endoscopy / Q000379:methods*; D006801:Humans; D007902:Length of Stay; D011446:Prospective Studies; D014472:Umbilicus
chemical_list: D000700:Analgesics