Video-assisted transumbilical appendectomy in children Curt S. Koontz, Lisa A. Smith * , Hans C. Burkholder, Kye Higdon, Robert Aderhold, Michael Carr Department of Surgery, University of Tennessee College of Medicine, Chattanooga Unit, Chattanooga, TN 37403, USA Abstract Background: Video-assisted transumbilical appendectomy (VATA) is a combination of laparoscopic and open techniques and is not widely used in children. We are reporting our most recent experience with this technique. Methods: After the institutional review board approval, the charts of patients who underwent VATA between December 2003 and October 2004 were retrospectively reviewed. All children presenting with a preoperative diagnosis of appendicitis were candidates. A 10-mm trocar was placed in the umbilicus. An operating laparoscope was used for mobilizing the appendix. The appendix was delivered through the umbilicus. A standard extracorporeal appendectomy was performed. The umbilical ring was closed and the wound irrigated. Demographic and outcome data were collected and is presented as mean F SD. Results: Sixty-one males and 50 females underwent VATA (n = 111). Age and weight were 11 F 3.2 years and 49 F 22 kg, respectively. Six patients had previous abdominal surgery. Operative time was 36 F 24 minutes (range, 9-140 minutes). An additional trocar was placed in 2 patients, and 2 patients were converted to open. Five patients had additional procedures. Appendicitis was classified intraoperatively as acute (n = 44), suppurative (n = 5), gangrenous (n = 8), ruptured (n = 30), appendiceal colic (n = 13), and other (n = 11). Preoperative antibiotics were given to 95 patients and were continued in 35 patients postoperatively. Length of stay was 1.8 F 1.7 days (range, 1-11 days). Length of follow-up was 13 F 6.3 days (n = 90). Complications included intra-abdominal abscess (n = 1) and wound infection (n = 7). Conclusions: Video-assisted transumbilical appendectomy minimizes equipment needs, thus, potentially reducing cost. Simple and complex appendectomies can be performed even if the patient has had previous abdominal surgery. Our complication rate was low, and our operating times and length of stay were short. Video-assisted transumbilical appendectomy is a safe and effective technique in children and can be used in lieu of the 3-trocar laparoscopic technique. D 2006 Elsevier Inc. All rights reserved. There are several advantages to laparoscopic appendecto- my (LA), including better visualization, better cosmesis, and possibly less pain. Moreover, LA has been shown to be safe and effective in simple and complicated appendicitis [1-6]. One disadvantage of LA is that equipment needs are higher and operating times may be longer, thus, increasing the cost of the procedure [7,8]. A hybrid of the open and laparoscopic techniques, the transumbilical appendectomy, has been reported but not widely used, especially in children [9-13]. This technique may offer advantages over the other 2 methods, including reduced equipment needs. At our 0022-3468/$ – see front matter D 2006 Elsevier Inc. All rights reserved. doi:10.1016/j.jpedsurg.2005.12.014 Presented at the 57th Annual Meeting of the Section on Surgery of the American Academy of Pediatrics, Washington, DC, October 7-9, 2005. * Corresponding author. Tel.: +1 423 778 7695; fax: +1 423 778 2950. E-mail address: lisa.smith@erlanger.org (L.A. Smith). Index words: Appendectomy; One trocar; Transumbilical; Laparoscopy Journal of Pediatric Surgery (2006) 41, 710 – 712 www.elsevier.com/locate/jpedsurg