Single-port transumbilical laparoscopic appendectomy: 43 consecutive cases.
BACKGROUND
In this modern era of minimally invasive surgery, cosmesis and early recovery are strongly emphasized. To reduce abdominal trauma and improve cosmesis, surgeons have adopted a single-port laparoscopic appendectomy for patients with acute appendicitis.


METHODS
From August to December 2008, 43 cases of appendectomy were managed using the single-port transumbilical laparoscopic technique. A multichannel single port was created using a surgical glove (no. 6), three trocars, one-three-way catheter, and a wound retractor (Alexis). An umbilical incision (1.5-2.0 cm) was made transumbilically or infraumbilically. The intraabdominal procedures were almost identical to those for conventional laparoscopic appendectomy. The methods for mesenteric dissection and appendiceal stump ligation were identical. Despite slight discomforts with retraction and visualization, the procedure was nevertheless possible. A resected appendix was put into a finger of the single-port glove.


RESULTS
The 43 study cases included 23 men and 20 women with a mean age of 31 years (range, 9-65 years) and a mean body mass index (BMI) of 22.3 kg/m(2) (range 15-29.7 kg/m(2)). The mean operative time was 61.3 min (range 24-120 min). Drainage was used in two cases with perforated appendicitis. Bowel movement returned at a mean of 1.2 days, and oral feeding was resumed on postoperative day 1.2. The pathology showed negative inflammation in 4 cases (9.3%), suppurative appendicitis in 29 cases (67.4%), gangrenous appendicitis in 8 cases (18.6%), and perforated appendicitis in 2 cases. Only one patient required readmission due to pericecal inflammation and pain, and another patient needed a percutaneous drainage of fluid collection. Three minor umbilical wound complications were controlled conservatively.


CONCLUSIONS
Single-port appendectomy may require a longer operative time than laparoscopic appendectomy, but it is a feasible technique with good cosmetic results. It could be one of the alternative methods for treating acute appendicitis.
Kim
Hyung Jin
HJ
Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, #505, Banpo-dong, Seocho-gu, Seoul, 137-701, Korea.
Lee
Jae Im
JI
Lee
Yoon Suk
YS
Lee
In Kyu
IK
Park
Jung Hyun
JH
Lee
Sang Kuon
SK
Kang
Won Kyung
WK
Cho
Hyeon-Min
HM
You
Young Kyuong
YK
Oh
Seong Taek
ST
D000293:Adolescent; D000328:Adult; D000368:Aged; D001062:Appendectomy / Q000295:instrumentation / Q000379:methods*; D002648:Child; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000295:instrumentation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery; D011183:Postoperative Complications; D055815:Young Adult
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