Single-incision Laparoscopic Surgery for Appendiceal Mucoceles: Safety and Feasibility in a Series of 16 Consecutive Cases

Abstract

Purpose: The aim of this study was to evaluate the technical feasibility, safety, and oncological outcomes of transumbilical single-incision laparoscopic surgery in patients with an uncomplicated appendiceal mucocele.

Methods: A review of a prospectively collected database at the Kyungpook National University Hospital from January 2006 to September 2010 revealed that a series of 16 consecutive patients underwent single-incision laparoscopic surgery (SILS) for an appendiceal mucocele. Data regarding patient demographics, operating time, conversion, surgical morbidity, lateral lymph node status, and mid-term oncologic result were analyzed.

Results: The reported series consisted of 7 women (50%) and 9 men with a mean age of 61.6 years (range, 41 to 88 years). The mean operative time was 66.8 minutes (range, 33 to 150 minutes). Perioperative mortality and morbidity were 0% and 6.2%, respectively. Recovery after the procedure was rapid, and the mean hospital stay was 6.8 days (range, 3 to 22 days). Pathology revealed 12 lesions compatible with a mucinous cystadenoma and four others compatible with benign cystic tumors. All surgical margins were clear. In one case, an extra port had to be placed, and another case required conversion from SILS to a standard open laparotomy immediately after identification of the tumor because of a micro-perforation with focal mucin collection. With a median follow-up of 28.7 months, no re-admission or tumor recurrence, such as pseudomyxoma peritonei, was noted in 14 patients.

Conclusion: A single-port laparoscopic mucocelectomy should be safe and feasible and has the advantage of being a minimally invasive approach. Prospective controlled studies comparing SILS and conventional open surgery, with long-term follow-up evaluation, are needed to confirm the author's initial experience.

Keywords: Appendiceal mucocele; Laparoscopy; Recurrence; Single-port.

Fig. 1

Intra-umbilical vertical skin incision and rectus fasciotomy to place the single-incision port.

Fig. 2

Actual single-incision port placement.

Fig. 3

Specimens within a sterile plastic pouch retrieved through the umbilical single incision site.

Fig. 4

Postoperative scar from a single-incision laparoscopic appendectomy.