Background: Laparoscopic appendectomy (LA) is the choice for treatment of acute appendicitis, mainly for young females because of the possibility of gynecologic illness. According to the new trends a scarless surgery is desirable. TUES and NOTES requires a selected subset of patients. We present a modified LA capable to resolve common or complicated cases for consecutive men and women, with no visible scars. Method: Under direct vision we intruduce both working ports below the pubic hair line and above the pubic bone; just medial to both lateral umbilical ligaments in order to avoid any damage to the deep epigastric vessels or the bladder, the 10mm camera port is placed into the umbilicus. This port distribution offers an excellent operative view with ergonomic advantages due to the relative high location of the appendix into the abdomen, even for complicated appendicitis or obese patients. Both working ports can be 5mm sized, using a 5mm harmonic scalpel or bipolar forceps. For the last 65 consecutive procedures we have change to two 3mm suprapubic ports, using a 3mm bipolar electrocautery and shifting a 3mm optics to the right suprapubic port to retrieve the appendix through the umbilicus, as well as a 5mm aspiration probe, if necessary, an endostapler may be inserted through the umbilicus for such a case of a broad based appendix and reserving the 5mm suprapubic ports for severely complicated cases. Results: Since 2005 we have operated 186 patients with only one complication (recurrent abscess) in a patient with a grade III appendicitis, as expected a standard technique, the average operating time was 25 minutes (7 min-90 min), the cosmetic result is superb, finding as well an unexpected low pain perception at the pubis. Conclusion: We encourage the use of this simple modification of the port placement for all patients suitable for LA, mainly in young women, because it is feasible even to deal with simple gynecologic disorders. Besides, at this moment the Scarless LA by Suprapubic approach clearly demonstrates advantages over the NOTES procedure because it can be done so much quickly, in patients with complicated disease, no matter how obese could be and finally, do not need to use the vagina as a point of entry and therefore, this procedure can be safely done in nubile women and males. Nevertheless in a near future the vertiginous advance of the NOTES technique can change our opinion or on the contrary, it can foment a hybridisation of techniques and therefore long term studies are mandatory.
Program Number: P514