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 McBurneyfs 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 McBurneyfs 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 McBurneyfs 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.
Program Number: P482