Purpose: Laparoscopic appendectomy isused as a three port technique for appendectomy. In children, single port laparoscopic appendectomy is difficult because they have a small peritoneal cavity for manipulation of laparoscopic instruments. We performed transumbilical laparoscopic assisted single port appendectomy (hybrid appendectomy) in children.
Methods: From March 2010 to July 2012, we performed transumbilical laparoscopic assisted single port appendectomy in 53 children. We made a vertical incision to the umbilicus approximately 1.5 cm, and a wound retractor (Applied Medical Resources Co., Ltd., Rancho Santa Margarita) was placed in the umbilical incision, and appendix exteriorized the extraperitoneum through the wound retractor. Appendectomy was performed conventionally. We had no conversion cases for laparotomy.
Results: A total of 53 patients, 29 females and 24 males, with a mean age of 8.5±2.0 years were enrolled in this retrospective study. The mean operative time was 29.4±9.4 minutes. There was no occurrence of complication or mortality. BMI was 17.8±4.9 kg/m². And mean hospital stay was 3.2±1.0 days.
Conclusion: In children, transumbilical single port laparoscopic appendectomy is technically difficult because they have a small peritoneal cavity. However, transumbilical laparoscopic assisted single port appendectomy (hybrid appendectomy) appearsto be a safe and effective technique for use in children, which allows for achievement of nearly scarless surgery.

Keywords Appendectomy, Laparoscopy, Children

1. Semm K. Endoscopic appendectomy. Endoscopy 1983;15:59-64.
   
2. Sajid MS, Khan MA, Cheek E, Baig MK, Needlescopic versus laparoscopic appendectomy: a systemic review. Can J Surg 2009;52:129-134.
   
3. Pelosi MA, Pelosi MA 3rd. Laparoscopic appendectomy using a single umbilical puncture (minilaparoscopy). J Reprod Med 1992;37:588-594.
   
4. Valla J, Ordorica-Flores RM, Steyaert H, et al. Umbilical one-puncture laparoscopic-assisted appendectomy in children. Surg Endosc 1999;13:83-85.
   
5. Ponsky TA, Diluciano J, Chwals W, Parry R, Boulanger S. Early experience with single-port laparoscopic surgery in children. J Laparoendosc Adv Surg Tech A 2009;19:551-553.
   
6. Rothenberg SS, Shipman K, Yoder S. Experience with modified single-port laparoscopic procedures in children. J Laparoendosc Adv Surg Tech A 2009;19:695-698.
   
7. Dutta S. Early experience wit h single incision laparoscopic surgery: eliminating the scar from abdominal operations. J Pediatr Surg 2009;44:1741-1745.
   
8. Garey CL, Laituri CA, Ostlie DJ, St Peter SD. A review of single site minimally invasive sur gery in infants and children. Pediatr Surg Int 2010;26:451-456.
   
9. Gilchrist BF, Lobe TE, Schropp KP, et al. Is there a role for laparoscopic appendectomy in pediatric surgery. J Pediatr Surg 1992;27:209-212.
   
10. Esposito C. One-trocar appendectomy in pediatric surgery. Surg Endosc 1998;12:177-178.
    
11. Valla J, Ordorica-Flores RM, Steyaert H, et al. Umbilical one-puncture laparoscopic-assisted appendectomy in children. Surg Endosc 1999;13:83-85.
    
12. D’Alessio A, Piro E, Tadini B, Beretta F. One-trocar transum bilical laparoscopic-assisted appendectomy in children: our experience. Eur J Pediatr Surg 2002;12:24-27.
    
13. Roberts KE. True single-port appendectomy: first experience with the “puppeteer technique”. Surg Endosc 2009;23:1825-1830.
    
14. Vidal O, Valentini M, Ginest ? C, et al. Laparoendoscopic single-site surgery appendectomy. Surg Endosc 2010;24:686-691.
    
15. Meyer A, Preuss M, Roesler S, Lainka M, Omlor G. Transumbilical laparoscopic-assisted “one-trocar”’ appendectomy TULAA-as an alternative operat ion method in the treatment of appendicitis. Zentralbl Chir 2004;129:391-395.
    
16. Visnjic S. Transumbilical laparoscopically assisted appendec tomy in children: high-tech low-budget surgery. Surg Endosc 2008;22:1667-1671.
    
17. Kala Z, Hanke I, Newmann C. A modified technique in laparoscopy-assisted appendectomy, a tra nsumbilical approach through a single port. Rozhl Chir 1996;75:15-18.
    
18. Rispoli G, Armellino MF, Esposito C. One-trocar appendectomy . Surg Endosc 2002;16:833-835.
    
19. Hong TH, You YK, Lee KH. Transumbilical single-port laparoscopic cholecystectomy: scarless cholecystectomy. Surg Endosc 2009;23:1393-1397.