Transumbilical Single-incision Laparoscopic Appendectomy Using Conventional Instruments: Single Working Channel Technique

Zheng Pan, Md PhD, Xiao-hua Jiang, PhD MD, Jia-hua Zhou, MD PhD, Zhen-ling Ji, MD PhD. Department of General Surgery, Zhongda Hospital, Southeast Univerisity Medical College, Nanjing, China

Abstract
Background: This study aimed to evaluate the feasibility, safety, and cosmetic results
of a novel technique: transumbilical single-incision laparoscopic appendectomy
(TSILA) by using a single working channel with conventional instruments.
Patients and Methods: The study enrolled 81 consecutive patients undergoing
laparoscopic appendectomy for acute appendicitis. TSILA was performed using a
single working channel and conventional laparoscopic instruments through a single 1.5 cm umbilical incision. Classic three-port laparoscopic appendectomy was performed using three trocars through three incisions. All the patients received a follow-up visit for 1 to 12 months.
Results: The study cohort consisted of 33 patients undergoing TSILA with an average age of 27.1(range 17–71) years. All 33 appendectomies were achieved through a single transumbilical incision. Forty-eight patients undergoing classic three-port laparoscopic appendectomy with an average age of 30.3(range 17–80) years. The mean operative time of TSILA didn’t show difference when compared with classic procedure (90.6 min vs. 76.5 min). No operative complications occurred in patients undergoing TSILA while two patients undergoing classic procedure showed incisional infection. The average postoperative hospital stay was 3.9 days in TSILA group and 3.5 days in classic procedure group with no difference. At the follow-up visit, no patient showed any evidence of incisional hernia. The transumbilical incisions were minimally visible, and all the patients undergoing TSILA reported a highly favorable cosmetic outcome.
Conclusion: The results of the study demonstrate that laparoscopic appendectomy can be achieved through a single umbilical incision and a single working channel using conventional instruments and that this approach is successful, safe, economic and aesthetic.
 

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