{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T14:14:42Z","timestamp":1787062482975,"version":"build-2736575974"},"reference-count":34,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2019,6,5]],"date-time":"2019-06-05T00:00:00Z","timestamp":1559692800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100007551","name":"Hallym University Medical Center","doi-asserted-by":"publisher","award":["HURF-2016-43"],"award-info":[{"award-number":["HURF-2016-43"]}],"id":[{"id":"10.13039\/501100007551","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and objectives: Single-port laparoscopic appendectomy (SLA) in most previous studies has used intracorporeal excision of the appendix and needed a longer operative time than multi-port laparoscopic appendectomy (MLA), although SLA does have the potential benefit of an almost invisible scar within the umbilicus. Some studies have reported that extracorporeal transumbilical single-incision laparoscopic-assisted appendectomy (TULAA) in children took a considerably reduced operative time compared to MLA. We adopted TULAA in adults, adding routine dissection of the peritoneal attachment of the appendix. The aim was to compare the operative outcomes between TULAA and MLA. Materials and Methods: Between March 2013 and January 2016, 770 patients with acute uncomplicated and complicated appendicitis from 15 to 75 years of age were enrolled retrospectively. The operation was performed as early (EA) and interval appendectomy (IA). Results: Operative time was shorter in the TULAA group than in the MLA group, except for IA. No open conversion occurred in the TULAA group, except one case of ileocecal resection for IA. No intra-abdominal fluid collection was found in the TULAA group. Extended resection (especially partial cecectomy) was performed less frequently in the TULAA group than in the MLA group for IA. Mean postoperative hospital stay was shorter in the TULAA group for uncomplicated appendicitis. When the data of the EA group and the IA group were compared, operative time was significantly shorter in the IA group for both MLA and TULAA. The open conversion rate and the complication rate tended to be lower in the IA group. Confined to IA, the TULAA group tended to have shorter mean initial, postoperative, and total hospital stays. Conclusions: TULAA can be a useful surgical alternative to MLA in adults and young adolescents, because it lacks open conversion and provides both a shorter operative time and a shorter postoperative hospital stay. TULAA is feasible for IA in that it showed a lower rate of extended resection and complications.<\/jats:p>","DOI":"10.3390\/medicina55060248","type":"journal-article","created":{"date-parts":[[2019,6,6]],"date-time":"2019-06-06T03:38:01Z","timestamp":1559792281000},"page":"248","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Transumbilical Single-Incision Laparoscopic-Assisted Appendectomy (TULAA) is Useful in Adults and Young Adolescents: Comparison with Multi-Port Laparoscopic Appendectomy"],"prefix":"10.3390","volume":"55","author":[{"given":"Seung Gyu","family":"Jin","sequence":"first","affiliation":[{"name":"Department of Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07441, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seong Hoon","family":"Cho","sequence":"additional","affiliation":[{"name":"Department of Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07441, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kwang Yong","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07441, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soo Kyung","family":"Ahn","sequence":"additional","affiliation":[{"name":"Department of Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07441, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ji Woong","family":"Hwang","sequence":"additional","affiliation":[{"name":"Department of Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07441, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ji Woong","family":"Cho","sequence":"additional","affiliation":[{"name":"Department of Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07441, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bong Wha","family":"Jung","sequence":"additional","affiliation":[{"name":"Department of Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07441, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0748-7136","authenticated-orcid":false,"given":"Byung Chun","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07441, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sang Nam","family":"Yoon","sequence":"additional","affiliation":[{"name":"Department of Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07441, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2019,6,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1199","DOI":"10.1007\/s00464-010-1344-z","article-title":"Laparoscopic versus open appendectomy for acute appendicitis: A metaanalysis","volume":"25","author":"Wei","year":"2011","journal-title":"Surg. Endosc."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1929","DOI":"10.1007\/s11605-012-1972-9","article-title":"Meta-analysis of the results of randomized controlled trials that compared laparoscopic and open surgery for acute appendicitis","volume":"16","author":"Ohtani","year":"2012","journal-title":"J. Gastrointest. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1825","DOI":"10.1007\/s00464-008-0270-9","article-title":"True single-port appendectomy: first experience with the \"puppeteer technique\"","volume":"23","author":"Roberts","year":"2009","journal-title":"Surg. Endosc."},{"key":"ref_4","first-page":"695","article-title":"One-wound laparoscopic cholecystectomy","volume":"84","author":"Navarra","year":"1997","journal-title":"Br. J. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"823","DOI":"10.1111\/j.1463-1318.2008.01660.x","article-title":"Single-port laparoscopy in colorectal surgery","volume":"10","author":"Remzi","year":"2008","journal-title":"Colorectal. Dis."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1013","DOI":"10.1007\/s00384-008-0519-8","article-title":"Single port access laparoscopic right hemicolectomy","volume":"23","author":"Bucher","year":"2008","journal-title":"Int. J. Colorectal. Dis."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"586","DOI":"10.1097\/SLA.0b013e31823003b5","article-title":"Single incision versus standard 3-port laparoscopic appendectomy: A prospective randomized trial","volume":"254","author":"Adibe","year":"2011","journal-title":"Ann. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1179","DOI":"10.1007\/s00595-014-1094-y","article-title":"Single-incision laparoscopic appendectomy versus conventional 3-port laparoscopic appendectomy for appendicitis: An updated meta-analysis of randomized controlled trials","volume":"45","author":"Xue","year":"2015","journal-title":"Surg. Today"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1089\/lap.2012.0284","article-title":"Comparative study between single-incision and three-port laparoscopic appendectomy: A prospective randomized trial","volume":"23","author":"Kye","year":"2013","journal-title":"J. Laparoendosc. Adv. Surg. Tech. Part A"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"950","DOI":"10.1016\/j.jamcollsurg.2013.12.052","article-title":"A prospective, randomized controlled trial of single-incision laparoscopic vs conventional 3-port laparoscopic appendectomy for treatment of acute appendicitis","volume":"218","author":"Carter","year":"2014","journal-title":"J. Am. Coll. Surg."},{"key":"ref_11","first-page":"492409","article-title":"Single-port transumbilical laparoscopic appendectomy: A preliminary multicentric comparative study in 87 patients with acute appendicitis","volume":"2012","author":"Vilallonga","year":"2012","journal-title":"Minim. Invasive Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1111\/jebm.12238","article-title":"Single-incision versus conventional three-incision laparoscopic appendectomy: A meta-analysis of randomized controlled trials","volume":"10","author":"Deng","year":"2017","journal-title":"J. Evid. Based Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1055\/s-2002-36846","article-title":"Transumbilical laparoscopic-assisted appendectomy (TULAA): A safe and useful alternative for uncomplicated appendicitis","volume":"12","author":"Pappalepore","year":"2002","journal-title":"Eur. J. Pediatr. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1177\/000313481107700513","article-title":"Transumbilical laparoscopic-assisted appendectomy: An extracorporeal single-incision alternative to conventional laparoscopic techniques","volume":"77","author":"Shekherdimian","year":"2011","journal-title":"Am. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1111\/ases.12111","article-title":"Role of the transumbilical laparoscopic-assisted single-channel, single-port procedure in an interval appendectomy for pediatric mass-forming appendicitis: A preliminary retrospective analysis","volume":"7","author":"Ohno","year":"2014","journal-title":"Asian J. Endosc. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"101","DOI":"10.4253\/wjge.v6.i4.101","article-title":"Transumbilical laparoscopic-assisted appendectomy in children: Clinical and surgical outcomes","volume":"6","author":"Zampieri","year":"2014","journal-title":"World J. Gastrointest. Endosc."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1016\/j.ijsu.2016.11.004","article-title":"Transumbilical laparoscopically assisted extracorporeal appendectomy in children and young adults: A retrospective cohort study","volume":"36","author":"Mohan","year":"2016","journal-title":"Int. J. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1288","DOI":"10.1016\/j.jpedsurg.2015.12.013","article-title":"Comparison of transumbilical laparoscopic-assisted appendectomy versus single incision laparoscopic appendectomy in children: which is the better surgical option?","volume":"51","author":"Boo","year":"2016","journal-title":"J. Pediatr. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"508","DOI":"10.1097\/SLE.0000000000000334","article-title":"Comparison of Transumbilical Laparoscopically Assisted Appendectomy to Conventional Laparoscopic Appendectomy in Children","volume":"26","author":"Karam","year":"2016","journal-title":"Surg. Laparosc. Endosc. Percutan. Tech."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"5372","DOI":"10.1007\/s00464-017-5618-6","article-title":"Transumbilical laparoscopic-assisted appendectomy in children: is it worth it?","volume":"31","author":"Ayuso","year":"2017","journal-title":"Surg. Endosc."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1016\/j.jpedsurg.2017.11.012","article-title":"Transumbilical extracorporeal laparoscopic-assisted appendectomy","volume":"53","author":"Perea","year":"2018","journal-title":"J. Pediatr. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"741","DOI":"10.1097\/SLA.0b013e31811f3f9f","article-title":"Nonsurgical treatment of appendiceal abscess or phlegmon: A systematic review and meta-analysis","volume":"246","author":"Andersson","year":"2007","journal-title":"Ann. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1117","DOI":"10.1177\/000313480106701201","article-title":"Ileocecectomy is definitive treatment for advanced appendicitis","volume":"67","author":"Lane","year":"2001","journal-title":"Am. Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s00595-006-3334-2","article-title":"Interval appendicectomy after appendiceal mass or abscess in adults: what is \"best practice\"?","volume":"37","author":"Corfield","year":"2007","journal-title":"Surg. Today"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"442","DOI":"10.1016\/j.amjsurg.2014.09.020","article-title":"Is there truly an oncologic indication for interval appendectomy?","volume":"209","author":"Wright","year":"2015","journal-title":"Am. J. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1007\/s004649900624","article-title":"One-trocar appendectomy in pediatric surgery","volume":"12","author":"Esposito","year":"1998","journal-title":"Surg. Endosc."},{"key":"ref_27","first-page":"588","article-title":"Laparoscopic appendectomy using a single umbilical puncture (minilaparoscopy)","volume":"37","author":"Pelosi","year":"1992","journal-title":"J. Reprod. Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"523","DOI":"10.1007\/s00464-011-1912-x","article-title":"Transumbilical laparoscopically assisted appendectomy in children: the results of a single-port, single-channel procedure","volume":"26","author":"Ohno","year":"2012","journal-title":"Surg. Endosc."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1187","DOI":"10.1007\/s00383-013-3373-x","article-title":"Single-incision laparoscopic-assisted appendectomy in children: exteriorization of the appendix is a key component of a simple and cost-effective surgical technique","volume":"29","author":"Deie","year":"2013","journal-title":"Pediatr. Surg. Int."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"632","DOI":"10.1016\/j.jamcollsurg.2016.07.015","article-title":"Interval Appendectomy: Finding the Breaking Point for Cost-Effectiveness","volume":"223","author":"Senekjian","year":"2016","journal-title":"J. Am. Coll. Surg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1158","DOI":"10.1177\/000313480006601213","article-title":"Is there a role for interval appendectomy in the management of acute appendicitis?","volume":"66","author":"Friedell","year":"2000","journal-title":"Am. Surg."},{"key":"ref_32","first-page":"109","article-title":"Interval appendectomy. A retrospective study","volume":"145","author":"Mosegaard","year":"1979","journal-title":"Acta Chir Scand"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1177\/000313481608200107","article-title":"A Systematic Review of Perforated Appendicitis and Phlegmon: Interval Appendectomy or Wait-and-See?","volume":"82","author":"Darwazeh","year":"2016","journal-title":"Am. Surg."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1016\/S1726-4901(09)70159-5","article-title":"Watchful waiting versus interval appendectomy for patients who recovered from acute appendicitis with tumor formation: A cost-effectiveness analysis","volume":"68","author":"Lai","year":"2005","journal-title":"J. Chin. Med. Assoc."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/55\/6\/248\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T12:56:29Z","timestamp":1760187389000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/55\/6\/248"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,6,5]]},"references-count":34,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2019,6]]}},"alternative-id":["medicina55060248"],"URL":"https:\/\/doi.org\/10.3390\/medicina55060248","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,6,5]]}}}