Single-port laparoscopic appendectomy conducted intracorporeally with the aid of a transabdominal sling suture

Abstract

Background/purpose: Laparoscopic appendectomy (LA) is becoming popular for the treatment of acute and perforated appendicitis. Since it was first described, LA has been modified various times. We present the results of a new technique of LA conducted through a single port without exteriorizing the appendix to perform the operation.

Materials and methods: Single-port LA was attempted in 38 patients (23 boys, 15 girls). Under general anesthesia, an 11-mm port with two 5-mm working channels or an 11-mm port through which a 10-mm scope (0 degrees) with a parallel eyepiece and a 6-mm working channel was inserted through the umbilicus. The appendix was grasped and dissected from the surrounding tissues with a single dissector or grasper. With a percutaneously inserted suture from the right lower quadrant into the peritoneal cavity, the appendix was pulled toward the abdominal wall after passing the suture through the mesoappendix. After mesenteric dissection with hook cautery, the base of the appendix was ligated with 2-0 polyglactin with a fisherman knot. The appendix was withdrawn into the trocar and extracted from the abdomen together with the trocar.

Results: Laparoscopic appendectomy was completed in 35 patients through a single port. A second port insertion was required in 3 patients. No peroperative and postoperative complications were encountered. Average duration of the procedure was 38 +/- 5.6 minutes.

Conclusion: This unique method further improves the minimal invasiveness of LA because a single port is used. Single-port intracorporeal appendectomy procedure is a safe, highly minimal invasive procedure with excellent cosmetic results.