**9. SIPES tips and tricks**

#### **9.1 Tips & Tricks in SIPES appendectomy**

SIPES appendectomy is increasing for its well-known cosmetic benefit. SIPES appendectomy is the most common procedure done in pediatric surgical units. The incision is strategically placed in the umbilicus with a perceived scarless abdomen. The technique is almost the same as in conventional procedure; it is performed

through a 1.5 cm umbilical incision. Single-incision port Medtronic 5–12 mm is placed using the open technique. The mesoappendix is divided by diathermy or sealing device, endo-loops is applied to secure the base of the appendix, and the appendix is then divided and retrieved through the port. Interferences and collisions between surgical instruments are worse than they are when conventional laparoscopic appendectomy (CLA) is performed using three incisions; this may extend the MOT. However, even with these challenges, difficult appendectomy can be completed successfully and safely by SIPES.
