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Klein T, Diesbach D, Boemers TM, Vahdad RM. Transumbilical laparoscopic-assisted appendectomy in children and adolescents: what have we learnt in more than 1200 cases? Langenbecks Arch Surg 2024; 409:263. [PMID: 39207589 DOI: 10.1007/s00423-024-03437-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 08/05/2024] [Indexed: 09/04/2024]
Abstract
PURPOSE TULAA combines the laparoscopic and open technique and is considered to be a safe, fast and cost-effective procedure. On the other hand, preparation is limited due to the single instrument, especially in complicated appendicitis. In this study we analyze the outcome of our TULAA patients, focusing on conversion and complication rates. METHODS We performed a retrospective study including all patients treated with TULAA in our department between 2006 and 2016. We analyzed patient data, operative data, costs, complications, and conversion rate to standard laparoscopic or open appendectomy. RESULTS 1275 children and adolescents were enrolled. Mean age was 10.2 years. TULAA was completed in 88% of cases. The overall mean operative time was 33 min. The overall complication rate was 5.7%. The most common complications were wound infection (2.7%), seroma (1.7%) and wound abscess (1.4%). Both the conversion rate and the complication rate were significantly higher in complicated appendicitis. Furthermore, the conversion rate is higher in overweight or obese patients. CONCLUSION TULAA is a safe, quick and cost-effective treatment option for acute appendicitis in children and adolescents. The complication rate and conversion rate are significantly correlated with the degree of appendiceal inflammation and comparable other surgical procedures.
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Affiliation(s)
- Tobias Klein
- Department of Pediatric Surgery and Pediatric Urology, Children's Hospital of Cologne, Kliniken der Stadt Köln gGmbH, Amsterdamer Straße 59, 50735, Cologne, Germany.
- Department of Pediatric Surgery and Pediatric Urology, University of Marburg, Marburg, Germany.
| | - D Diesbach
- Department of Pediatric Surgery and Pediatric Urology, Children's Hospital of Cologne, Kliniken der Stadt Köln gGmbH, Amsterdamer Straße 59, 50735, Cologne, Germany
| | - T M Boemers
- Department of Pediatric Surgery and Pediatric Urology, Children's Hospital of Cologne, Kliniken der Stadt Köln gGmbH, Amsterdamer Straße 59, 50735, Cologne, Germany
| | - Reza M Vahdad
- Department of Pediatric Surgery and Pediatric Urology, University of Marburg, Marburg, Germany
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Zundel S, Singer N, Florinett L, Aichner J, Jhala T, Szavay P. Development and assessment of a loop ligation simulator for laparoscopic appendectomy. Pediatr Surg Int 2024; 40:86. [PMID: 38512596 PMCID: PMC10957642 DOI: 10.1007/s00383-024-05664-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/21/2024] [Indexed: 03/23/2024]
Abstract
OBJECTIVE Loop ligation of the appendix is a challenging surgical skill and well suited to be trained in a simulator. We aimed to develop an affordable and easy-to-build simulator and test its training effect. DESIGN AND PARTICIPANTS Different materials were tested, and the best training modality was identified by researching the literature. The developed simulator training was tested on 20 surgical novices. RESULTS A video was produced including an instruction on how to build the simulator and a step-by-step tuition on how to ligate the appendix. The Peyton approach was utilized to guide learners. Training with the simulator leads to reliable skill acquisition. All participants improved significantly in completing the task successfully during the structured learning. CONCLUSION We succeeded in developing a simulator for loop ligation of the appendix during laparoscopic appendectomy. Participants significantly improve in handling the loops. The transferability of the skill learned during simulation to the operating room will be subject of a follow-up study.
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Affiliation(s)
- Sabine Zundel
- Department of Pediatric Surgery, Children's Hospital Lucerne, 6000, Lucerne 16, Switzerland.
| | | | | | - Jonathan Aichner
- Department of Pediatric Surgery, Children's Hospital Lucerne, 6000, Lucerne 16, Switzerland
| | - Tobias Jhala
- Department of Pediatric Surgery, Children's Hospital Lucerne, 6000, Lucerne 16, Switzerland
| | - Philipp Szavay
- Department of Pediatric Surgery, Children's Hospital Lucerne, 6000, Lucerne 16, Switzerland
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Curwen O, Gaber M, Gerogiannis I. In Pursuit of the Most Cost-Effective Laparoscopic Appendicectomy: A Review of the Literature. Surg Innov 2023; 30:601-606. [PMID: 37080159 DOI: 10.1177/15533506231169072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
PURPOSE To review the literature and identify the most economical techniques for laparoscopic appendicectomy (LA) that do not compromise on patient care. METHODS We performed a search of the Cochrane Library, PubMed, EMBASE and Google Scholar for papers published between January 2001 and January 2021. The outcomes of the included studies were then grouped by theme of cost analysis, with the main areas of focus being the use of disposable equipment, appendiceal stump closure, and retrieval of the appendix. RESULTS After screening a total of 254 search results, 40 studies were included, representing 13 285 patient outcomes, having two main areas of focus: the use of reusable or disposable equipment and the different methods of appendiceal stump closure. Use of disposable instruments has been cost effective in LA in 2 studies. However, use of reusable trocars has reduced cost of procedure by €250 in another study. Appendiceal stump closure using ligature, endoloops or Endoclips had been cost-effective compared to Endostaplers in 25 studies. This can save up to €350. Endoscopic specimen bags are single use and represent further disposable equipment costs. The use of a sterile glove to replace this piece of kit can further provide cost benefit as shown in 2 studies. CONCLUSION Laparoscopic appendicectomy can be performed in a variety of ways with equivocal patient safety. We present the use of extracorporeal ligature of the appendiceal base, combined with the use of a surgical glove retrieval system as the most economic technique in laparoscopic appendicectomy.
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Affiliation(s)
- Oliver Curwen
- Department of General and Emergency Surgery, Kingston Hospital NHS Foundation Trust, London, UK
| | - Mohannad Gaber
- Department of General and Emergency Surgery, Kingston Hospital NHS Foundation Trust, London, UK
| | - Ioannis Gerogiannis
- Department of General and Emergency Surgery, Kingston Hospital NHS Foundation Trust, London, UK
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4
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Variability in pediatric appendectomy: The association between disposable supply cost and procedure duration. Surgery 2022; 172:729-733. [DOI: 10.1016/j.surg.2022.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 03/28/2022] [Accepted: 04/07/2022] [Indexed: 11/23/2022]
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DeMare AM, Luehmann NC, Kawak S, Abbott EE, Long J, Akay B, Brahmamdam P, Iacco AA, Novotny NM. Cost-Effective Approach to the Laparoscopic Appendectomy : Balancing Disposable Instrument Cost With Operative Time. Am Surg 2020; 86:715-720. [PMID: 32683956 DOI: 10.1177/0003134820923337] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Surgeons can help reduce health care spending by selecting affordable and efficient instruments. The laparoscopic appendectomy (LA) is commonly performed and can serve as a model for improving health care cost. METHODS We retrospectively reviewed all adult patients who underwent LA for non-perforated appendicitis from March 2015 to November 2017. Our objective was to determine which combination of disposable instruments afforded the lowest total operative cost without compromising postoperative outcomes. RESULTS In total, 1857 consecutive patients were reviewed from 2 hospitals. After determining the 8 most commonly utilized combinations of disposable instruments, 846 patients were ultimately analyzed. The combination of a LigaSure, Endoloop, and an EndoBag (LEB) had the shortest median operative time (25 minutes, P < .001) and lowest median total operative cost ($1893, P < .001). CONCLUSIONS The LEB instrument combination rendered the shortest operative time, lowest total operative cost, and can be used to maximize surgical value during LA.
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Affiliation(s)
| | | | - Samer Kawak
- 7005 Department of Surgery, Beaumont Health, Royal Oak, MI, USA
| | - Emily E Abbott
- 7005 Department of Surgery, Beaumont Health, Royal Oak, MI, USA
| | - Jordan Long
- 7005 Department of Surgery, Beaumont Health, Royal Oak, MI, USA
| | - Begum Akay
- 7005 Section of Pediatric Surgery, Beaumont Children's Hospital, Royal Oak, MI, USA.,Department of Surgery, Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Pavan Brahmamdam
- 7005 Section of Pediatric Surgery, Beaumont Children's Hospital, Royal Oak, MI, USA.,Department of Surgery, Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Anthony A Iacco
- 7005 Department of Surgery, Beaumont Health, Royal Oak, MI, USA.,Department of Surgery, Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Nathan M Novotny
- 7005 Section of Pediatric Surgery, Beaumont Children's Hospital, Royal Oak, MI, USA.,Department of Surgery, Oakland University William Beaumont School of Medicine, Rochester, MI, USA.,Department of Pediatric Surgery, Monroe Carell, Jr. Children's Hospital at Vanderbilt, Vanderbilt University School of Medicine, Nashville, TN, USA
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Trö RB. Re: "In Pursuit of the Most Cost-Effective Pediatric Laparoscopic Appendectomy: The Effect of Disposable Instrument Choice on Operative Time and Surgeon-Controllable Cost" (J Laparoendosc Adv Surg Tech A 2017;27:1309-1313). J Laparoendosc Adv Surg Tech A 2018; 28:628-629. [PMID: 29653059 DOI: 10.1089/lap.2018.0084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ralf-Bodobs Trö
- Department of Pediatric Surgery, Marienhospital, St.-Elisabeth-Gruppe, Ruhr University Bochum , Herne, Germany
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