title: The "all-in-one" appendectomy: quick, scarless, and less costly.
abstract: BACKGROUND
  A technique for laparoscopic appendectomy (LAP APPY) that involves brief surgeon and operating room times, results in no appreciable scar, and requires few disposable supplies would be desirable.
  
  
  METHODS
  During 2009, 508 children underwent LAP APPY at our institution including 398 (78%) for acute, non-perforated appendicitis. Our "all-in-one" operative procedure involves use of a single instrument through a side-arm viewing operative laparoscope which is inserted through a single, trans-umbilical port. Successful procedure completion rates and operative times ("cut-to-close") were determined. Our data for surgeon-directed, disposable supply costs per procedure were collated by Child Health Corporation of America and compared with 2009 LAP APPY data (n = 5692) from 17 other children's hospitals in the United States.
  
  
  RESULTS
  We successfully completed 359 (90.2%) LAP APPY procedures using the all-in-one technique resulting in no appreciable scar. Additional ports were used in 9.8% and there were no conversions to open procedures. Median operative time for the all-in-one technique was 24 minutes (5-66 min). Our median surgeon-directed, disposable supply cost was the lowest in the study group and significantly less than the other 17 children's hospitals ($166 vs $748, P < .001). Median variation of supply costs among surgeons within each institution was $448 ($3-$870). Aggregate savings of nearly $1.3 million are predicted if all study surgeons were to reduce their disposable costs per procedure to the 25th percentile ($551).
  
  
  CONCLUSIONS
  We conclude that the all-in-one laparoscopic appendectomy technique is quick, scarless, and less costly than conventional multi-port techniques. Wider application of the all-in-one technique seems indicated.
authors.affiliation: Miami Children's Hospital, Florida International University College of Medicine, Miami, FL, USA. sstylianos@nshs.edu
authors.forename: Steven
authors.initials: S
authors.lastname: Stylianos
authors.forename: Lucas
authors.initials: L
authors.lastname: Nichols
authors.forename: Nestor
authors.initials: N
authors.lastname: Ventura
authors.forename: Leopoldo
authors.initials: L
authors.lastname: Malvezzi
authors.forename: Colin
authors.initials: C
authors.lastname: Knight
authors.forename: Cathy
authors.initials: C
authors.lastname: Burnweit
mesh_terms: D000900:Anti-Bacterial Agents / Q000191:economics / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis / Q000191:economics; D001062:Appendectomy / Q000191:economics / Q000295:instrumentation / Q000379:methods* / Q000706:statistics & numerical data; D001064:Appendicitis / Q000601:surgery; D002648:Child; D002921:Cicatrix / Q000517:prevention & control; D017046:Cost Savings; D004209:Disposable Equipment / Q000191:economics; D016527:Drug Costs / Q000706:statistics & numerical data; D017721:Hospital Costs / Q000706:statistics & numerical data; D006776:Hospitals, Pediatric / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D010535:Laparoscopy / Q000191:economics / Q000379:methods* / Q000706:statistics & numerical data; D007902:Length of Stay / Q000191:economics; D013525:Surgical Instruments / Q000191:economics; D013530:Surgical Wound Infection / Q000188:drug therapy / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control; D013997:Time Factors; D014472:Umbilicus; D014481:United States / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents