MDCT navigation for LA via a single umbilical incision

Introduction: Although three ports laparoscopic appendectomy is traditional procedure, it needs the application of much expensive endoscopic instrumentation for resection and removal of the appendix . We studied the cases of three-dimensional (3D) imaging using Multi-detector CT (MDCT) to demonstrate the anatomical location of appendix clearly and of laparoscopic appendectomy via a single umbilical incision.
Materials and Methods: We performed MDCT in 42 patients of acute appendicitis between August 2006 and August 2008. The locations of the base of the appendix and McBurneyfs point were marked on a coronal image. The distances from umbilicus to the base of the appendix (UB), and the distances from the base of the appendix to McBurneyfs point (BM) were meseaured. In some cases, 3D-CT image were reformed for the laparoscopic appendectomy.
Laparoscopic procedures: A 1.5 cm skin incision was made in the base of the umbilicus and the abdominal wall was lifted by retractor. A scope and a grasper were introduced into the abdominal cavity through this incision. The operator imaged the location of the appendix by 3D-CT information, grasped, dissected the appendix from the surrounding tissues, and delivered through the same incision. The appendectomy was performed using conventional ligation method outside the abdominal cavity.
Result: The UB was 9.5}1.6 cm and BM was 2.7}1.6 cm.@The base of appendix was located exactly at McBurneyfs point in only 3% among patients. When the laparoscopic view is directed to the target on McBurney’s point, 92% cases of the base of appendix is located within the range 30‹right to 30‹ left. Laparoscopic appendectomy were attempted in 12 patients, the mean operation time was 61 minutes. The mean postoperative stay was 5 days. All patients have no clinical problem and no visible umbilical scar.
Conclusion: 3D-CT image can provide useful information for the location of the appendix and helpful for surgical navigation as viewpoint of a surgeon or pre-operative surgical planning. This single umbilical incision procedure minimizes the skin incision and shows a better cosmetic and lower cost result compared to three ports laparoscopic appendectomy.

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Program Number: P482

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