**5.1.2 Needlescopic appendectomy**

Needlescopic appendectomy can be safe and effective according to a recent review and is supposed to reduce pain compared to conventional laparoscopy (Sajid et al., 2009; Sauerland et al., 2010). Nevertheless it is associated with a longer operating time and a higher conversion rate. Multicenter, randomized controlled trials are recommended before it can be used routinely.

#### **5.1.3 Robotic appendectomy**

Incidental appendectomy is considered to eventually be necessary in women with ovarian endometrioma and chronic pelvic pain, as the majority of the appendices are found to have histopathologically confirmed pathology although being macroscopically normal (Wie et al., 2008). Incidental robotic appendectomy is reported to be safe and effective in women undergoing gynaecologic surgery, in women with chronic pelvic pain, and women with ovarian malignancy (Akl et al., 2008). In the latter group three out of seven patients were found to have appendicular metastasis. Our experience with the DaVinci (TM, Intuitive Surgical Inc.) Robotic System started in 2006, and is today the everyday routine of the

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**7. Acknowledgements** 

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**8. References** 

department in advanced procedures. We performed incidental robotic appendectomy in three patients who underwent gynecologic surgery for endometriosis for chronic pelvic pain with good results. We believe that the robotic procedure has its place in complicated cases of appendicitis with dense peritoneal adhesions.
