Pediatric Surgery International

, Volume 29, Issue 11, pp 1187–1191 | Cite as

Single-incision laparoscopic-assisted appendectomy in children: exteriorization of the appendix is a key component of a simple and cost-effective surgical technique

  • Kyoichi Deie
  • Hiroo UchidaEmail author
  • Hiroshi Kawashima
  • Yujiro Tanaka
  • Takayuki Masuko
  • Shinya Takazawa
Original Article



Single-incision laparoscopic appendectomy was recently introduced as a less-invasive surgical technique than existing methods, and is increasingly being performed worldwide. We have started to perform transumbilical laparoscopic-assisted appendectomy (TULAA) in children. In this study, we assessed its feasibility, efficacy, and cost-effectiveness compared with conventional multiport laparoscopic appendectomy (MLA).


We retrospectively reviewed all of the patients who underwent MLA or TULAA between August 2009 and December 2012. Patient characteristics, operative time, length of hospital stay, postoperative complications, cost-effectiveness, and cosmetic results were analyzed.


A total of 88 patients underwent laparoscopic appendectomy, with MLA in 48 patients and TULAA in 40 patients. TULAA was successful in 36/40 patients. There were no significant differences in mean operative time or mean length of stay between the two groups of patients. There were no postoperative complications in the TULAA group. The cost of TULAA was much lower than that of MLA. TULAA also provided nearly scarless surgery.


TULAA, in which the appendix is exteriorized via a combination of open and laparoscopic techniques, is a safe and effective procedure for treating appendicitis in children. TULAA is a cost-effective treatment that provides excellent cosmetic results.


Children Laparoscopic appendectomy Single incision Cost-effectiveness Exteriorization 


  1. 1.
    Semm K (1983) Endoscopic appendectomy. Endoscopy 15:59–64PubMedCrossRefGoogle Scholar
  2. 2.
    Pelosi MA, Pelosi MA 3rd (1992) Laparoscopic appendectomy using a single umbilical puncture (minilaparoscopy). J Reprod Med 37:588–594PubMedGoogle Scholar
  3. 3.
    Stanfill AB, Matilsky DK, Kalvakuri K et al (2010) Transumbilical laparoscopically assisted appendectomy: an alternative minimally invasive technique in pediatric patients. J Laparoendosc Adv Surg Tech A 20:873–876. doi: 10.1089/lap.2010.0147 PubMedCrossRefGoogle Scholar
  4. 4.
    Ohno Y, Morimura T, Hayashi S (2012) Transumbilical laparoscopic-assisted appendectomy in children: the results of a single-port, single-channel procedure. Surg Endosc 26:523–527. doi: 10.1007/s00464-011-1912-x PubMedCrossRefGoogle Scholar
  5. 5.
    St Peter SD, Adibe OO, Juang D et al (2011) Single incision versus standard 3-port laparoscopic appendectomy: a prospective randomized trial. Ann Surg 254:586–590. doi: 10.1097/SLA.0b013e31823003b5 PubMedCrossRefGoogle Scholar
  6. 6.
    Frutos MD, Abrisqueta J, Lujan J et al (2013) Randomized prospective study to compare laparoscopic appendectomy versus umbilical single-incision appendectomy. Ann Surg 257:413–418. doi: 10.1097/SLA.0b013e318278d225 PubMedCrossRefGoogle Scholar
  7. 7.
    Gilchrist BF, Lobe TE, El-Marsafawy M et al (2001) Is there a role for laparoscopic appendectomy in pediatric surgery? J Pediatr Surg 27:209–212CrossRefGoogle Scholar
  8. 8.
    Eypasch E, Sauerland S, Lefering R, Neugebauer EA (2002) Laparoscopic versus open appendectomy: between evidence and common sense. Dig Surg 19:518–522PubMedCrossRefGoogle Scholar
  9. 9.
    Vegunta RK, Ali A, Wallece LJ et al (2004) Laparoscopic appendectomy in children: technically feasible and safe in all stages of acute appendicitis. Am Surg 70:198–202PubMedGoogle Scholar
  10. 10.
    Hansen JB, Smithers BM, Schache D et al (1996) Laparoscopic versus open appendectomy: prospective randomized trial. World J Surg 20:17–20PubMedCrossRefGoogle Scholar
  11. 11.
    Hay SA (1998) Laparoscopic versus conventional appendectomy in children. Pediatr Surg Int 13:21–23PubMedCrossRefGoogle Scholar
  12. 12.
    D’Alessio A, Piro E, Tadini B, Beretta F (2002) One-trocar transumbilical laparoscopic-assisted appendectomy in children: our experience. Eur J Pediatr Surg 12:24–27PubMedCrossRefGoogle Scholar
  13. 13.
    Koontz CS, Smith LA, Burkholder HC, Higdon K, Aderhold R, Carr M (2006) Video-assisted transumbilical appendectomy in children. J Pediatr Surg 41:710–712PubMedCrossRefGoogle Scholar
  14. 14.
    Hong TH, Kim HL, Lee YS et al (2009) Transumbilical single-port laparoscopic-assisted appendectomy (TUSPLA): scarless intracorporeal appendectomy. J Laparoendosc Adv Surg Tech 19:75–78. doi: 10.1089/lap.2008.0338 CrossRefGoogle Scholar
  15. 15.
    Dutta S (2009) Early experience with single-incision laparoscopic surgery: eliminating the scar from abdominal operations. J Pediatr Surg 44:1741–1745. doi: 10.1016/j.jpedsurg.2008.12.024 PubMedCrossRefGoogle Scholar
  16. 16.
    Ponsky TA, Diluciano J, Chwals W, Parry R, Boulanger S (2009) Early experience with single-incision laparoscopic surgery in children. J Laparoendosc Adv Surg Tech 19:551–553. doi: 10.1089/lap.2009.0092 CrossRefGoogle Scholar
  17. 17.
    Ignacio RC, Burke R, Spencer D, Bissell C, Dorsainvil C, Lucha PA (2004) Laparoscopic versus open appendectomy: what is the real difference? Results of a prospective randomized double-blinded trial. Surg Endosc 18:334–337PubMedCrossRefGoogle Scholar
  18. 18.
    Visnjic S (2008) Transumbilical laparoscopic-assisted appendectomy in children: high-tech low-budget surgery. Surg Endosc 22:1667–1671PubMedCrossRefGoogle Scholar
  19. 19.
    Rispoli G, Armellino MF, Esposito C (2002) One-trocar appendectomy. Surg Endosc 16:833–835PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Kyoichi Deie
    • 1
  • Hiroo Uchida
    • 1
    Email author
  • Hiroshi Kawashima
    • 1
  • Yujiro Tanaka
    • 1
  • Takayuki Masuko
    • 1
  • Shinya Takazawa
    • 1
  1. 1.Department of Pediatric SurgerySaitama Children’s Medical CenterSaitamaJapan

Personalised recommendations