title: SINGLE-ACCESS TRANSUMBILICAL LAPAROSCOPIC APPENDECTOMY USING CURVED REUSABLE INSTRUMENTS: AN INITIAL REPORT OF THREE CASES.
abstract: BACKGROUND
  The continuous evolution of laparoscopic surgery and the ambition of better cosmetic results raise the need for less invasive procedures. The umbilicus represents a natural scar and constitutes a well-healing site of access to the peritoneal cavity. Single-access Transumbilical Laparoscopy (SATL) is gaining popularity and can be an alternative surgical treatment for acute appendicitis. We report three cases of SATL appendectomy using curved reusable instruments.
  
  
  METHODS
  Three female patients, wanting minimal scarring (mean age - 30 years) were admitted to our hospital in April 2015 with acute abdominal pain in the right iliac area. A SATL appendectomy was performed using a standard 11-mm reusable trocar for a 10-mm, 30 degrees- angled, rigid scope and curved reusable instruments according to DAPRI (Karl Storz-Endoskope, Tuttlingen, Germany) placed transumbilically.
  
  
  RESULTS
  Neither a conversion to open surgery nor an insertion of extraumbilical trocars was necessary. The mean operative time was 101.6 ± 24.66 minutes and the mean blood loss 6.66 ± 11.54 mL. The mean scar length was 16.66 ± 0.57 mm. No intraoperative complications were registered and the use of minimal pain killers allowed the discharge after 2 or maximum 4 days. After three months of follow-up no late complications occurred and the umbilical scar was not visible.
  
  
  CONCLUSIONS
  In young and scarless-demanding females with acute appendicitis SATL appendectomy can be performed safely and offers the possibility of surgical treatment without a visible scar.
authors.forename: K
authors.initials: K
authors.lastname: Grozdev
authors.forename: G
authors.initials: G
authors.lastname: Velev
authors.forename: G
authors.initials: G
authors.lastname: Prodanova
authors.forename: A
authors.initials: A
authors.lastname: Koichev
authors.forename: K
authors.initials: K
authors.lastname: Angelov
authors.forename: G
authors.initials: G
authors.lastname: Todorov
mesh_terms: D000328:Adult; D001062:Appendectomy / Q000295:instrumentation* / Q000379:methods; D001064:Appendicitis / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D001065:Appendix / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D004867:Equipment Design; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000295:instrumentation* / Q000379:methods; D014463:Ultrasonography; D055815:Young Adult