Transumbilical laparoscopic appendectomy for acute appendicitis: a reliable one-port procedure

Abstract

Background: Emergency surgical procedures frequently must be performed at times when availability of adequately trained personnel is problematic yet the requirements for maintaining surgical quality and patient safety remain unchanged. This report aims to describe a safe, effective, transumbilical, one-port laparoscopic technique for appendectomy that can be performed by one surgeon.

Methods: Between January 2006 and December 2008, transumbilical one-port laparoscopic appendectomy (TOPLA) was used by two pediatric surgeons in the authors' department to treat 152 consecutive patients presenting with simple and complicated appendicitis. With the patient placed in the Trendelenburg position and rotated to the left, a single surgeon was easily able to perform the procedure using a 10-mm 0° operative laparoscope (Karl Storz) with a 5-mm working channel. The appendix was lifted with transabdominal suspensory sutures to facilitate its removal. The results were compared with those for 112 patients receiving open appendectomy (OA) during the same period.

Results: The operative time was significantly shortened using TOPLA (mean, 61.5 min) compared with using OA (mean, 118.3 min) (p = 0.000). Despite significantly higher numbers of patients with complicated appendicitis enrolled in the TOPLA arm of the study, the rate of wound infection was significantly lower after TOPLA (0%, 0/152) than after OA (9.8%, 11/112) (p = 0.000). The number of patients requesting intramuscular or intravenous analgesics for pain relief was significantly lower after TOPLA than after OA. The overall results for TOPLA were comparable with those for the more common three-port laparoscopic procedure, but it offers the alternative of having an inconspicuous scar hidden within the umbilicus.

Conclusion: This report describes a simple and safe laparoscopic procedure that offers an effective way for one surgeon to treat simple and complicated appendicitis through a single port with satisfactory cosmetic outcomes.