Abstract
Aim
This survey reviewed the practice of laparoscopic appendectomy in pediatric surgical centers across Europe.
Methods
An online survey questionnaire was created and data obtained analyzed.
Results
There were 58 responders (52 Consultants and 6 trainees), of them n = 24 performed > 100 laparoscopic procedures per year. Procedures were performed by trainee with scrubbed consultant supervision n = 30, trainee with unscrubbed consultant n = 14, independent trainees n = 8 and consultants n = 6. Optic port preferences were 10 mm (n = 29), 5 mm (n = 24) and 12 mm (n = 3). Working port placement preference was sectorization n = 32, triangulation n = 16 and n = 10 decided based on intraoperative findings. Mesoappendix was dissected by monopolar hook n = 26, bipolar forceps n = 20, harmonic devices n = 8, and bipolar scissors n = 4. Appendix ligation was done with 3 vicryl endoloops (n = 36), 2 vicryl endoloops (n = 13), 3 polydioxanone (PDS) endoloops (n = 7) and endostaplers (n = 2). Appendix was removed through optic 10–12 mm port (n = 27), exchanging 5 mm for 10–12 mm port (n = 9), endobag (n = 8), sterile glove digit endobag (n = 7), through 5 mm ports (n = 5) and along 5 mm port (n = 2). In complicated appendicitis, n = 48/58 would proceed with laparoscopy on prior confirmed perforation and n = 53/58 would continue with laparoscopy when intraoperative findings showed complicated appendicitis. In the presence of pus, n = 52/58 would perform peritoneal lavage and n = 4/58 would only suction pus. Complicated appendices were removed via endobag n = 30, through 10–12 mm port n = 10, sterile glove digit n = 10, exchange 5 mm for 10–12 mm port n = 7 and along with work port n = 1.
Conclusion
Opinions were divided with regards to approach in performing various steps of pediatric laparoscopic appendectomy in institutions throughout Europe.
References
Semm K (1983) Endoscopic appendectomy. Endoscopy 15:59–64
Dingemann J, Metzelder ML, Szavay PO (2013) Current status of laparoscopic appendectomy in children: a nation wide survey in Germany. Eur J Pediatr Surg 23:226–233
Gause CD, Hsiung G, Schwab B, Clifton M, Harmon CM, Barsness KA (2016) Advances in pediatric surgical education: a critical appraisal of two consecutive minimally invasive pediatric surgery training courses. J Laparoendosc Adv Surg Tech A 26:663–670
Cairo SB, Harmon CM, Rothstein DH (2018) Minimally invasive surgical exposure among US and Canadian pediatric surgery trainees, 2004–2016. J Surg Res 231:179–185
Kuo HH, Li Y, Wang CJ, Juang HT, Lee CY (2017) A case-controlled study comparing harmonic versus electrosurgery in laparoscopic myomectomy. Taiwan J Obstet Gynecol 56:73–76
Bulian DR, Knuth J, Sauerwald A, Ströhlein MA, Lefering R, Ansorg J, Heiss MM (2013) Appendectomy in Germany—an analysis of a nationwide survey 2011/2012. Int J Colorectal Dis 28:127–138
Obrist NM, Tschuor C, Breitenstein S, Vuille-Dit-Bille RN, Soll C (2019) Appendectomy in Switzerland: how is it done? Updates Surg 71:375–380
Nataraja RM, Panabokke G, Chang AD, Mennie N, Tanny ST, Keys C et al (2019) Does peritoneal lavage influence the rate of complications following pediatric laparoscopic appendicectomy in children with complicated appendicitis? A prospective randomized clinical trial. J Pediatr Surg. https://doi.org/10.1016/j.jpedsurg.2019.08.039
Snow HA, Choi JM, Cheng MW, Chan ST (2016) Irrigation versus suction alone during laparoscopic appendectomy; a randomized controlled equivalence trial. Int J Surg 28:91–96
Aziret M, Çetinkünar S, Erdem H, Kahramanca Ş, Bozkurt H, Dülgeroğlu O et al (2017) Comparison of open appendectomy and laparoscopic appendectomy with laparoscopic intracorporeal knotting and glove endobag techniques: a prospective observational study. Turk J Surg 33:258–266
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Mehmood, T., Saxena, A.K. European multicenter survey on approaches in pediatric laparoscopic appendectomy. J Ped Endosc Surg 1, 175–179 (2019). https://doi.org/10.1007/s42804-019-00035-8
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s42804-019-00035-8