Article

Single-site umbilical laparoscopic appendectomy

Department of Surgery and Center for Prospective Clinical Trials, Children's Mercy Hospital, Kansas City, Missouri 64108, USA.
Seminars in Pediatric Surgery (Impact Factor: 2.22). 11/2011; 20(4):196-200. DOI: 10.1053/j.sempedsurg.2011.05.003
Source: PubMed

ABSTRACT

Laparoscopic appendectomy has become the standard approach in most institutions for children with nonperforated appendicitis, and in many institutions for patients with perforated appendicitis. Because of public perception and continued surgical innovation, there has been an impetus to perform operations with fewer and fewer scars, ultimately moving toward "scarless" surgery. Improvements in the laparoscopic technique and instrumentation have led to multiple reports of appendectomy in children being performed by the use of a single-incision approach. Although this approach remains an unproven benefit compared with a traditional laparoscopic appendectomy, the pressures to adopt single-incision appendectomy will continue to increase. This article will review the background of laparoscopy for appendectomy, the introduction of the single-incision approach, available data and outcomes from current literature, and a description of our technique.

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    • "Recently, numerous reports appeared in the literature describing the so-called SILS (single-incision laparoscopic Minimally Invasive Surgery surgery) technique where a single umbilical trocar is used to introduce three or four instruments or, as an alternative, at the umbilical site a subcutaneous pocket is created and the natural umbilical fascial defect plus one or two other stab incisions are used to place cannulas (or only instruments) to perform an endocorporeal laparoscopic appendectomy [4] [5] [12]. However, this kind of approach results in longer operating times than standard multiport laparoscopic appendectomy because of the clashing of instruments [12] [13], and it does not have the remarkable reduction in costs that the single trocar operative scope have, compared to standard laparoscopic technique [9] [10]. "
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    ABSTRACT: The paper reports the results of a retrospective review of the medical charts of 203 patients admitted to a pediatric surgical unit with a diagnosis of acute appendicitis between January 2006 and December 2010 when a transumbilical laparoscopic-assisted appendectomy (TULAA) was introduced as a new surgical technique. Among 203 admitted patients, 7 (3.5%) had a localized appendiceal abscess and were treated with antibiotics. All of them responded to antibiotics and underwent TULAA interval appendectomy 8 weeks later. 196 patients (96.5%) underwent immediate surgery. In 12/181 (6.6%) urgent cases, conversion to laparotomy was necessary, in 3 patients because of bowel distension and in 9 for retrocecal position of appendix. In all 181 TULAA completed procedures, one trocar was used in 151 cases (89.4%), two trocars in 16 (9.4%), and three trocars in 2 (1.2%). The mean operative time for single port TULAA was 52' Complications included 5 wound infections and 5 intra-abdominal abscesses, all managed conservatively. In conclusion, TULAA is a safe, minimally invasive approach with acute appendicitis, regardless of the perforation status, and can be recommended in the pediatric urgical settings.
    Full-text · Article · Mar 2013 · Minimally Invasive Surgery
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    • "Recently, numerous reports appeared in the literature describing the so-called SILS (single-incision laparoscopic Minimally Invasive Surgery surgery) technique where a single umbilical trocar is used to introduce three or four instruments or, as an alternative, at the umbilical site a subcutaneous pocket is created and the natural umbilical fascial defect plus one or two other stab incisions are used to place cannulas (or only instruments) to perform an endocorporeal laparoscopic appendectomy [4] [5] [12]. However, this kind of approach results in longer operating times than standard multiport laparoscopic appendectomy because of the clashing of instruments [12] [13], and it does not have the remarkable reduction in costs that the single trocar operative scope have, compared to standard laparoscopic technique [9] [10]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The paper reports the results of a retrospective review of the medical charts of 203 patients admitted to a pediatric surgical unit with a diagnosis of acute appendicitis between January 2006 and December 2010 when a transumbilical laparoscopic-assisted appendectomy (TULAA) was introduced as a new surgical technique. Among 203 admitted patients, 7 (3.5%) had a localized appendiceal abscess and were treated with antibiotics. All of them responded to antibiotics and underwent TULAA interval appendectomy 8 weeks later. 196 patients (96.5%) underwent immediate surgery. In 12/181 (6.6%) urgent cases, conversion to laparotomy was necessary, in 3 patients because of bowel distension and in 9 for retrocecal position of appendix. In all 181 TULAA completed procedures, one trocar was used in 151 cases (89.4%), two trocars in 16 (9.4%), and three trocars in 2 (1.2%). The mean operative time for single port TULAA was 52 í®í° Complications included 5 wound infections and 5 intra-abdominal abscesses, all managed conservatively. In conclusion, TULAA is a safe, minimally invasive approach with acute appendicitis, regardless of the perforation status, and can be recommended in the pediatric urgical settings.
    Full-text · Dataset · Feb 2013
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    ABSTRACT: The benefits of the three-port laparoscopic appendectomy (TPLA) are now appreciated. Included in these advantages are reduced postoperative pain, reduced hospitalization, early return to routine activities, and a definite cosmetic benefit over the open approach. Recently, the single-incision laparoscopic technique for several disease processes has been popularized. The single-incision approach through the umbilicus is ideally suited for patients with nonperforated appendicitis. This article will review our operative technique for both the TPLA and single-incision laparoscopic appendectomy, and then review the available literature that compares benefits of one approach over the other. When comparing these two approaches, variables that will be discussed include infectious complications, operative time and cost, and the need for postoperative pain medication.
    No preview · Article · Jun 2012 · European Journal of Pediatric Surgery
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