Single-access transumbilical laparoscopic appendectomy and cholecystectomy using new curved reusable instruments: a pilot feasibility study

The umbilicus can be considered as the embryological opening for single-access laparoscopic procedures. We report on single-access transumbilical laparoscopic appendectomy (SATLA) and cholecystectomy (SATLC), performed using new curved reusable instruments.

A retrospective review of a prospectively maintained database of 30 patients who underwent SATLA and 20 patients who underwent SATLC between May and November 2009 was undertaken. All procedures were performed with an 11-mm nondisposable trocar for the scope, and curved reusable instruments (Karl Storz-Endoskope, Tuttlingen, Germany) placed transumbilically without trocars. Outcome measures were conversion to standard laparoscopy, operative time, scar length, complications, hospital stay, and use of pain medication.

All SATLA patients had acute appendicitis, and SATLC patients had symptomatic gallstones (15), chronic cholecystitis (3), and acute cholecystitis (2). No extraumbilical trocars were necessary. Mean total operative times were 57.3 ± 15.9 min (SATLA) and 73.9 ± 20.1 min (SATLC). Mean laparoscopic times were 39 ± 13.1 min (SATLA) and 57.5 ± 18.9 min (SATLC). Mean scar lengths were 14.8 ± 2.2 mm (SATLA) and 15.8 ± 2.3 mm (SATLC). Five SATLA patients and one SATLC patient developed postoperative complications. Mean hospital stay was 2.9 ± 1.3 days for SATLA patients and 1.8 ± 0.8 days for SATLC patients. Pain medication used was minimal. At the minimum follow-up of 3 months no late complications were registered.

SATLA and SATLC can be performed safely using curved reusable instruments, which helps avoid the conflict between the surgeon's hands or between the instruments' tips and allows the surgeon to operate in an ergonomic position. The reusable instruments kept the cost similar to that of classic laparoscopy.