Gasless transumbilical laparoscopic-assisted appendectomy as a safe and cost-effective alternative surgical procedure for mild acute appendicitis.
OBJECTIVE
Several reports have demonstrated the effectiveness and feasibility of single incisional transumbilical laparoscopic-assisted appendectomy (TULAA). We developed a modified TULAA technique, gasless-TULAA, which involves lifting the abdominal wall with a retractor, without pneumoperitoneum or another incision.


METHODS
We assessed the surgical outcomes of 257 patients treated for appendicitis in our hospital between 2005 and 2013. In a preoperative comprehensive evaluation, appendicitis without abscess was defined as mild appendicitis (mild appendicitis group: MAG), and appendicitis with abscess was defined as severe appendicitis (severe appendicitis group: SAG). The clinical outcomes were compared with those in other published reports. The cost-effectiveness of gasless-TULAA was compared with that of conventional multiport laparoscopic appendectomy (CMLA) in our hospital.


RESULTS
In MAG (n = 228), the operation time and postoperative hospital stay were 46.9 ± 22.7 min and 2.6 ± 1.2 days, respectively. The gasless-TULAA was completed without trocars in 91.2 % of patients. The surgical outcomes of SAG were significantly worse than those of MAG (p < 0.001). The surgical cost of gasless-TULAA was significantly lower than that of CMLA (p < 0.001).


CONCLUSIONS
Gasless-TULAA is a cost-effective, safe, and readily available surgical technique for mild appendicitis, which can obviate the need for specialized equipment.
Department of Surgery, Toyonaka Municipal Hospital, 4-13-1 Shibaharacho, Toyonaka, Osaka, 560-8565, Japan.|Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka E-2, Suita, Osaka, 565-0871, Japan.
Koji
K
Munakata
Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka E-2, Suita, Osaka, 565-0871, Japan. muemura@gesurg.med.osaka-u.ac.jp.
Mamoru
M
Uemura
Department of Surgery, Toyonaka Municipal Hospital, 4-13-1 Shibaharacho, Toyonaka, Osaka, 560-8565, Japan. junzo-s@orh.go.jp.|Department of Surgery, Osaka Rosai Hospital, 1179-3 Nagasonecho, Kita-ku, Sakai City, Osaka, 591-8025, Japan. junzo-s@orh.go.jp.
Junzo
J
Shimizu
Department of Surgery, Toyonaka Municipal Hospital, 4-13-1 Shibaharacho, Toyonaka, Osaka, 560-8565, Japan.
Masakazu
M
Miyake
Department of Surgery, Toyonaka Municipal Hospital, 4-13-1 Shibaharacho, Toyonaka, Osaka, 560-8565, Japan.|Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka E-2, Suita, Osaka, 565-0871, Japan.
Taishi
T
Hata
Department of Surgery, Toyonaka Municipal Hospital, 4-13-1 Shibaharacho, Toyonaka, Osaka, 560-8565, Japan.|Department of Surgery, Minoh City Hospital, 5-7-1 Kayano, Minoh City, Osaka, 562-0014, Japan.
Kimimasa
K
Ikeda
Department of Surgery, Toyonaka Municipal Hospital, 4-13-1 Shibaharacho, Toyonaka, Osaka, 560-8565, Japan.
Keizo
K
Dono
Department of Surgery, Toyonaka Municipal Hospital, 4-13-1 Shibaharacho, Toyonaka, Osaka, 560-8565, Japan.
Masashi
M
Kitada
Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka E-2, Suita, Osaka, 565-0871, Japan.
Yuichiro
Y
Doki
Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka E-2, Suita, Osaka, 565-0871, Japan.
Masaki
M
Mori
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D001062:Appendectomy / Q000191:economics* / Q000295:instrumentation / Q000379:methods*; D001064:Appendicitis / Q000601:surgery*; D002648:Child; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000191:economics* / Q000295:instrumentation / Q000379:methods*; D008297:Male; D011028:Pneumoperitoneum, Artificial; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014472:Umbilicus / Q000601:surgery*; D055815:Young Adult
Appendicitis; Gasless transumbilical laparoscopic-assisted appendectomy; Minimum invasive surgery; Single incision