Single-Port Hybrid Open and Laparoscopic Approach for Pediatric Appendectomy for Acute Appendicitis
Yuki Noguchi, MD, PhD; Shogo Saito, MD; Shohei Hiwatashi, MD, PhD; Satoshi Umeda, MD, PhD; Masahiro Zenitani, MD, PhD; Keigo Nara, MD, PhD
Osaka Women’s and Children’s Hospital

Acute appendicitis is one of the most common surgical conditions in pediatric patients, and laparoscopic appendectomy is widely accepted as the standard treatment. However, conventional multi-port laparoscopic techniques and intracorporeal single-port approaches can be technically demanding in children due to the limited intra-abdominal working space and instrument interference.

This case involved a 4-year 9-month-old girl presenting with acute abdominal pain and vomiting. Ultrasonography demonstrated appendiceal enlargement with suspected appendicolith, supporting the diagnosis of acute appendicitis and indicating a potential risk of progression and recurrence.

To address both anatomical and technical considerations, a hybrid laparoscopic–open appendectomy using a single umbilical incision was adopted. A small longitudinal incision was made at the umbilicus, and a wound protector with a multiport cap was applied. Adequate exposure was confirmed when the surgeon could insert an index finger into the abdominal cavity. The laparoscopic component was limited to identifying and grasping the appendix, which was then retracted and exteriorized through the umbilical incision. Appendectomy was performed extracorporeally under direct visualization, thereby avoiding technically demanding intracorporeal maneuvers. In this case, the degree of inflammation was mild, allowing smooth mobilization and uncomplicated extracorporeal removal.

This hybrid approach simplifies the procedure while preserving the advantages of minimally invasive surgery, including reduced operative complexity and improved cosmetic outcomes, and represents a practical option for pediatric appendicitis.