An Optimal, Cost-effective Laparoscopic Appendectomy Technique for Our Surgical Residents

Abstract

Since early 1999, we have implemented a standardized technique for laparoscopic appendectomy, which is simple, safe and easily learned and mastered by our residents. Besides superior ergonomics, it offers cosmetic advantages. It is inexpensive as only reusable instruments are used. It incorporates useful modifications, such as the use of suprapubic ports, inferior approach with repositioning of the videoscope from the umbilical port to the left suprapubic port, laparoscopic gauze swabs and instrument-assisted knotting, as well as skeletonization of the appendix. We analyze the outcome of this technique between January 2000 and December 2002. The overall conversion rate of 713 laparoscopic appendectomies was 8.7%, which is comparable with the "best" rates in international literature. Operative times (mean, 59.0 minutes) and the complication rate (6.7%) compared favorably with previous reports on resident training. In summary, our residents feel comfortable with our standardized approach, while producing acceptable results with low cost.

Laparoscopic appendectomy by residents: evaluating outcomes and learning curve

“…We found that patient outcomes in resident-performed laparoscopic appendectomies in our study were comparable to those quoted in previous studies [8,20]. When we compared the two groups, we found significant reduction in operative duration and complication rates.…”

The versatile laparoscopic sponge

“…As a routine, we thoroughly swab the peritoneal and pelvic cavity only after sucking out all exudates at the end of a laparoscopic appendectomy for severe appendicitis with localized soiling. In a recent audit of 713 laparoscopic appendectomies, our overall postoperative intraabdominal abscess rate stood at 0.7%, which compares favorably with figures from most reported laparoscopic appendectomy series (average of 15 series, 1.82%), while being comparable to that of open appendectomy (average of 15 series, 0.83%), despite the fact that 98.6% of the cases were done by surgical residents in an emergency setting [7].…”

SAGES guideline for laparoscopic appendectomy

“…There is very little level I evidence comparing particular techniques, however some level II and III evidence suggests that developing a consistent method decreases costs and OR time and decreases complications [20,33]. This applies to laparoscopic appendectomy performed in a training program.…”