The purpose of this video is to detail the technical aspects of video-assisted transumbilical appendectomy. This video is a compilation of both surgical and laparoscopic videos filmed during appendectomy, using the technique detailed here.

The technique for removal of the appendix detailed in the video begins with transumbilical trocar placement followed by video localization and laparoscopic mobilization of the appendix. The laparoscope used is a 10 mm instrument with a 5 mm working port. Once the appendix is mobile, the tip is grasped and delivered through the transumbilical incision where a standard appendectomy is performed using laparotomy instruments: the mesoappendix is clamped between hemostats and ligated with absorbable suture while a Babcock clamp stabilizes the cecum at the umbilicus; the base of the appendix is crushed, clamped, doubly-ligated, and transected with care to leave a stump of less than 5 mm. The mucosa of the appendiceal stump is cauterized and the cecum returned to the abdomen. The umbilical ring is then reapproximated using one or two sutures and the umbilical skin tucked down but not sutured.

Debate continues over whether laparoscopic appendectomy is the best option for children over open appendectomy. The techniques detailed in this video demonstrate that combining video-assistance to localize, mobilize, and deliver the appendix into the wound using an operating laparoscope with a standard appendectomy could minimize operating time and hospital cost while providing excellent cosmesis. Video-assisted transumbilical appendectomy combines the cosmesis of laparoscopy, going one step better by using a single incision hidden in the umbilicus, with the low cost and speed of the open appendectomy by not using expensive disposables and multiple trocars.