Researchers at Miami Children's Hospital (MCH; FL, USA) reported on the results of 508 LAP APPY procedures performed during 2009, including 398 (78%) for acute, nonperforated appendicitis. The researchers determined successful procedure completion rates and operative times, as well calculating data for surgeon-directed, disposable supply costs per procedure, which were compared to similar data on 5,692 LAP APPY procedures completed at 17 other children's hospitals in the United States.

The results showed that the researchers successfully completed 359 (90.2%) LAP APPY procedures using the all-in-one technique, with no appreciable scar tissue forming; additional ports were used in 9.8% of the children, and there were no conversions to open procedures. Median operative time for the all-in-one technique was 24 minutes, and the disposable supply cost was the lowest in the entire study group of 17 institutions, amounting to only USD 177; the median variation of supply costs among all surgeons within each institution was USD 448. The study was published in the December 2011 issue of the Journal of Pediatric Surgery.

“The ‘all-in-one’ LAP APPY operative procedure involves use of a single instrument through a side-arm viewing operative laparoscope which is inserted through a single, transumbilical port,” concluded lead author Steven Stylianos, MD, and colleagues of the department of pediatric surgery. “The technique is quick, scarless, and less costly than conventional multiport techniques. Wider application of the all-in-one technique seems indicated.”

Single-port transumbilical laparoscopy, also known as embryonic natural orifice transumbilical endoscopic surgery (E-NOTES), has emerged as an attempt to further enhance cosmetic benefits and reduce morbidity of minimally invasive surgery. Additional ports are rarely required, and no new scars are added, since the procedure makes use of the existing scar (the umbilicus), which is an embryological natural orifice.

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