Periumbilical Multiport Laparoscopic Appendectomy: A Preliminary Experience Using a Novel Technique

Abstract

Background: Single incision laparoscopic surgery (SILS) is especially developed to achieve better cosmetic results. Using the umbilicus for ports access is widely accepted in this approach. Objectives: The aim of this study was to evaluate our initial experience with a new port access technique applied for laparoscopic appendectomy: Periumbilical Multiport Laparoscopic Appendectomy (PUMLA). Patients and Methods: Between January 2011 and March 2013, a total of 14 appendectomies were performed using a new port access technique. Patients were selected randomly. Thirteen of these cases had acute appendicitis, and one patient had familial Mediterranean fever (FMF). During these operations, three separate curvilinear incisions were created in the periumbilical skin folds and ports were placed in these ways. The five millimeter port was used for a zero degree telescope. The other two were used to manipulate the laparoscopic instruments. The appendectomy was performed intracorporeally in six cases; however, in eight cases, the appendix was taken out via a trocar after dissecting the mesoappendix, then the appendectomy was performed extracorporeally. Reconstruction was not needed to the umbilicus as there was no anatomical distortion. Results: Five patients were female, and nine were male. Age range was 5 to 15 years (mean 9.7 years). Operation time was between 20 and 82 minutes (mean 43 minutes). We did not need to convert to standard laparoscopic appendectomy or place an additional port in any of these patients. The average postoperative hospitalization was 14.1 hours (5-33 h). No complications such as wound infection, trocar site hernia, adhesive small-bowel obstruction, or abscess were observed in the early and late postoperative period. Good cosmetic results were obtained after the separate periumbilical curvilinear incision technique. Conclusions: We found that this new port access technique is feasible, safe, and associated with good cosmetic results.