Editing Appendectomy (section)

===Incisions===
The standardization of an incision is not best practice when performing an appendectomy given that the appendix is a mobile organ.<ref name=":2" /> A physical exam should be performed prior to the operation and the incision should be chosen based on the point of maximal tenderness to palpation.<ref name=":2" />

These incisions are placed for appendectomy:
# McBurney's incision, also known as grid iron incision
# Lanz incision
# Rutherford Morison incision
# Paramedian incision

[[File:Appendectomy plus 10 days.png|thumb|Wound healing - ten days after a laparoscopic appendectomy]]
Over the past decade, the outcomes of laparoscopic appendectomies have compared favorably to those for open appendectomies<ref>{{Cite journal |last=Jaschinski |first=Thomas |last2=Mosch |first2=Christoph G |last3=Eikermann |first3=Michaela |last4=Neugebauer |first4=Edmund AM |last5=Sauerland |first5=Stefan |date=2018-11-28 |editor-last=Cochrane Colorectal Cancer Group |title=Laparoscopic versus open surgery for suspected appendicitis |url=https://doi.wiley.com/10.1002/14651858.CD001546.pub4 |journal=Cochrane Database of Systematic Reviews |language=en |volume=2018 |issue=11 |doi=10.1002/14651858.CD001546.pub4 |pmc=6517145 |pmid=30484855}}</ref> because of decreased pain, fewer postoperative complications, shorter hospitalization, earlier mobilization, earlier return to work, and better [[cosmesis]]; however, despite these advantages, efforts are still being made to decrease abdominal incision and visible scars after laparoscopy.<ref>{{Cite book|title=Zollinger's Atlas of Surgical Operations|last=Zollinger|first=Robert|publisher=McGraw-Hill Education|year=2016|isbn=978-0-07-179756-6|pages=49}}</ref> Recent research has led to the development of [[natural orifice transluminal endoscopic surgery]] (NOTES); however, numerous difficulties need to be overcome before a wider clinical application of NOTES is adopted, including complications such as the opening of hollow viscera, failed sutures, a lack of fully developed instrumentation, and the necessity of reliable cost-benefit analyses.<ref name="journalofmas.com">{{cite journal | last1 = Ashwin | first1 = Rammohan | last2 = Paramaguru | first2 = Jothishankar | last3 = Manimaran | first3 = A. B. | last4 = Naidu | first4 = R. M. | year = 2012 | title = Two-port vs. three-port laparoscopic appendicectomy: A bridge to least invasive surgery | journal = Journal of Minimal Access Surgery | volume = 8 | issue = 4 | pages = 140–144 | doi = 10.4103/0972-9941.103121 | pmid = 23248441 | pmc = 3523451 | url = http://www.journalofmas.com/text.asp?2012%2F8%2F4%2F140%2F103121 | access-date = 2012-11-10 | archive-date = 2018-06-01 | archive-url = https://web.archive.org/web/20180601221648/http://www.journalofmas.com/text.asp?2012%2F8%2F4%2F140%2F103121 | url-status = live | doi-access = free }}</ref>

Many surgeons have attempted to reduce incisional morbidity and improve cosmetic outcomes in laparoscopic appendectomy by using fewer and smaller ports. Kollmar'' et al.'' described moving laparoscopic incisions to hide them in the natural camouflages like the suprapubic hairline to improve cosmesis. Additionally, reports in the literature indicate that minilaparoscopic appendectomy using 2– or 3-mm or even smaller instruments along with one 12-mm port minimizes pain and improves cosmesis. More recently, studies by Ates ''et al.'' and Roberts ''et al.'' have described variants of an {{Linktext|intracorporeal}} sling-based single-port laparoscopic appendectomy with good clinical results.<ref name="journalofmas.com"/>

Also, a trend is increasing towards single-incision laparoscopic surgery (SILS), using a special multiport umbilical trocar.<ref>{{Cite journal|last1=Far|first1=Sasan Saeed|last2=Miraj|first2=Sepide|date=October 2016|title=Single-incision laparoscopy surgery: a systematic review|journal=Electronic Physician|volume=8|issue=10|pages=3088–3095|doi=10.19082/3088|issn=2008-5842|pmc=5133033|pmid=27957308}}</ref> With SILS, a more conventional view of the field of surgery is seen compared to NOTES. The equipment used for SILS is familiar to surgeons already doing laparoscopic surgery. Most importantly, it is easy to convert SILS to conventional laparoscopy by adding a few trocars; this conversion to conventional laparoscopy is called 'port rescue'. SILS has been shown to be feasible, reasonably safe, and cosmetically advantageous, compared to standard laparoscopy; however, this newer technique involves specialized instruments and is more difficult to learn because of a loss of triangulation, clashing of instruments, crossing of instruments (cross triangulation), and a lack of maneuverability.<ref name="journalofmas.com"/>  The additional problem of decreased exposure and the added financial burden of procuring special articulating or curved coaxial instruments exist. SILS is still evolving, being used successfully in many centres, but with some way to go before it becomes mainstream. This limits its widespread use, especially in rural or peripheral centres with limited resources.<ref name="journalofmas.com"/>