单切口腹腔镜阑尾切除术。（Mariano Palermo，Guillermo Duza）

                               
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Surgical Technique:

The patient must be placed in a dorsal decubitus position, and the left arm must be preferably close to the body.
The navel is grasped by two Allis clamps and is reflected. A transumbilical incision is made with a scalpel.
The aponeurosis is dissected with a scissors creating a supra aponeurotic space cephalad and a second 5mm trocar is placed through the same skin incision.
A 10 mm trocar is placed with the Hasson technique and the abdomen is insuflated with CO2 (12 mmHg), a 30 degree 10 mm endocamera is placed. Concentric exploration of the cavity is carried out.
The second 5 mm trocar is placed with a cephalad incision, in parallel to the 10mm trocar in the supra aponeurotic space previously created.
The appendix is located and grasped.
A14G catheter over needle (Abocath®) is placed in the right iliac fossa, and a suture passed in order to create proper tension on the appendix.
Catheter over needle sheath (Abocath®) inserted in the cavity under direct visualization.
A 0 Prolene® suture is passed creating a snare through the catheter. The appendix is passed inside and pulled towards the abdominal wall, thus creating the tension and straightening necessary for an adequate triangulation. A tip:  during this step change the placement of the catheter over needle and Prolene® in order to always have proper tension and visualization of the caecal and meso-appendix.
The meso-appendix is coagulated with a Hook device, utilizing monopolar electrocautery.  Also a harmonic scalpel can be used. During this step it is necessary to always have a 5mm clip applier available in case any bleeding may present during the coagulation of the meso-appendix.
Ligation of the appendicular base and distal ligation with Vicryl® or Prolene® 0 external sutures/knots positioned and descended with a Maryland dissector.
Sectioning of the appendix with scissors between ligations.
If necessary, irrigation and aspiration of the abdominal cavity. A specimen bag is placed through a 10 mm trocar and the amputated caecal appendix is grasped and inserted in the bag for its extraction.
The 10 mm trocar is removed. The aponeurosis between both trocars is sectioned with an electronic scalpel.
Removal of the surgical specimen inside the bag.
Posterior closure of the aponeurosis and skin, reconstruction of the navel.
Skin closure with separated 3-0 Nylon sutures.