One trocar appendectomy is a combination of laparoscopic and open appendectomy. The advantage, along with improved cosmesis, is the possibility to introduce a dissection instrument through the optical trocar without an additional incision. In this prospective study the sense of one trocar appendectomy is evaluated in daily practise for a cohort of consecutive patients with suspected acute appendicitis. Twenty-two patients were enrolled. One-trocar appendectomy was successful in 13 patients. In 8 patients one extra 2, 5 or 10 millimetre trocar was necessary. In one patient a third trocar was necessary. Conversion to an open appendectomy through a grid iron incision was not necessary. The pathologist confirmed the diagnosis of acute appendicitis in all patients. The average operation time was 53 minutes. Complications included one wound abscess and one wound haematoma. In conclusion one trocar appendectomy is a good and safe technique in patients with the suspicion of acute appendicitis, provided that the operative team must be experienced in laparoscopic surgery and the constitution of the patient is suitable for this technique.