Yes, an appendectomy can be performed through a single umbilical incision using SILS (single-incision laparoscopic surgery). All instruments pass through one port at the navel instead of three separate ports, leaving one small scar hidden inside the umbilicus. The operation is identical in steps and outcome just more technically demanding and not suitable for every case.

According to Dr. Rajeev Premnath, a trusted General and Laparoscopic Surgeon, “SILS appendectomy works well for younger patients with uncomplicated appendicitis who prioritise cosmetic outcome one small scar inside the belly button, essentially invisible once healed. For perforation or abscess, standard three-port laparoscopy is the safer choice.”

SILS and standard laparoscopic appendectomy achieve the same result through different port configurations the differences matter for patient selection and operative planning.

• Port setup: Standard laparoscopy uses three separate ports for triangulated access. SILS uses one umbilical port, forcing instruments to run parallel rather than at angles.
• Cosmetic outcome: Three-port laparoscopy leaves three small abdominal scars. SILS leaves one scar hidden inside the umbilicus effectively invisible once healed.
• Operative difficulty: Parallel instruments cause handle clashing and restricted movement, extending operating time and demanding specific surgeon training.
• Conversion rate: SILS converts to three-port laparoscopy more often than standard laparoscopy converts to open surgery. Adding a second port when needed does not compromise outcomes.

The decision between SILS and standard laparoscopy is made at assessment, not in theatre. For a full overview of appendix treatment options, visit our appendix treatment page.

Patient selection determines whether SILS is the right approach it isn’t appropriate for all presentations of appendicitis.

• Uncomplicated appendicitis: SILS suits acute, uncomplicated cases without perforation, abscess, or peritoneal contamination.
• BMI and body habitus: Lean patients with a thin abdominal wall offer the best operative conditions for SILS.
• Prior abdominal surgery: Previous lower abdominal surgery raises adhesion risk, making three-port access safer and more flexible.
• Complicated appendicitis: Perforation, abscess, and gangrenous appendix require better access and drainage standard three-port laparoscopy is the safer choice.

SILS and standard laparoscopy produce equivalent clinical outcomes in suitable patients. Our blog on single incision laparoscopic surgery covers how the technique works across different procedures.

Dr. Rajeev Premnath is a General and Laparoscopic Surgeon with MBBS, MS (Gen Surg.), FRCS (Glasg.), FEBS, FICS, FACS, FIAGES, FMAS, and a Diploma in Laparoscopy from France, with over 20 years of experience in laparoscopic and single incision surgery including appendectomy across all complexity grades at Ramakrishna Super Speciality Hospital, Jayanagar, Bangalore.

Each appendicitis case is assessed individually before any operative approach is confirmed presentation severity, body habitus, and prior surgical history all factor into whether SILS or standard laparoscopy is the right call, and patients are counselled on both options before the decision is made.

References:

1. Sajid MS et al. Single incision versus conventional laparoscopic appendectomy. Journal of Gastrointestinal Surgery. 2012.
2. Rehman H et al. Single-incision laparoscopic appendectomy versus conventional three-port laparoscopic appendectomy. Cochrane Database. 2011.