Gasless single-incision laparoscopic appendectomy

Single-incision laparoscopic surgery has received increasing attention recently. This report describes a novel technique for single-incision laparoscopic appendectomy. From August 2008 to October 2009, 69 consecutive patients with acute appendicitis underwent gasless single-incision laparoscopic appendectomy under epidural anesthesia at our department. An approximately 1.8-cm-long incision was made at McBurney's point. Once the abdominal wall was entered, an abdominal wall lifting device was employed in the right lower quadrant to lift up the abdominal wall to establish the operating space. Appendectomies were accomplished by use of three techniques: extracorporeally, combined extra- and intracorporeally, and intracorporeally. A drainage tube was inserted in right iliac fossa through the small incision when severe inflammation at the base of appendix or local peritonitis was present at time of operation. Of the 69 patients, 66 underwent successful gasless single-incision laparoscopic appendectomy. In the remaining three patients the procedure was converted to open by extending the length of the incision at McBurney's point. Average operative time was 51 min (range 38-72 min). Abdominal cavity was drained in four patients. Patients resumed mobility within 24 h postoperatively. No complications occurred intraoperatively. Postoperative complication occurred in two patients: localized abscess in one, and wound infection in another; both were treated successfully with conservative management. Appendectomy can be safely performed through gasless single-incision laparoscopic surgery. Further study is required to investigate any potential advantage of this method over conventional laparoscopic techniques.