A Critical Analysis of Laparoscopic Appendectomy: How Experience with 1,400 Appendectomies Allowed Innovative Treatment to Become Standard in a University Hospital
Background Although advantages of laparoscopic appendectomy (LA) have not yet been proved, there is increasing evidence that LA provides diagnostic and therapeutic advantages as compared to conventional surgery. This article reports the introduction of LA in a university hospital where LA now repres...
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| Veröffentlicht in: | World journal of surgery 2008-07, Vol.32 (7), p.1406-1413 |
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| creator | Schick, Kerstin S. Hüttl, Thomas P. Fertmann, Jan M. Hornung, Hans-Martin Jauch, Karl-Walter Hoffmann, Johannes N. |
| description | Background
Although advantages of laparoscopic appendectomy (LA) have not yet been proved, there is increasing evidence that LA provides diagnostic and therapeutic advantages as compared to conventional surgery. This article reports the introduction of LA in a university hospital where LA now represents the standard operative procedure in patients with suspected appendicitis.
Methods
Consecutive patients with appendectomy were prospectively included in the surgical database from 5/1991 to 10/2005. Operating time skin-to-skin in minutes, conversion from laparoscopy to open appendectomy, and complications requiring reoperation as well as surgical expertise were recorded.
Results
After initial performance of LA by four experienced specialists in laparoscopic surgery between 1991 and 1994, LA was routinely implemented from 1995 to 2005. Laparoscopic appendectomy was performed in 1,012 patients, and conventional appendectomy in 449 patients, with a LA rate of about 90% in recent years. Intraoperative conversion was deemed necessary in 62 patients (6.2 %) by 40 surgeons among the 103 surgeons who performed LA over 14 years with a mean operative time of 57 ± 2 min. Between 1995 and 2005 about 25%–30% of LAs were performed as the first LA for the respective surgeon. Laparoscopic appendectomy was associated overall with a reduced length of stay in the hospital compared to open appendectomy (LA: 4.4 ± 0.1 days versus 6.6 ± 0.2 in open appendectomy;
p
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| doi_str_mv | 10.1007/s00268-007-9429-0 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_69221124</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>69221124</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4493-41b74f4f311473672870cecc28d7880963dfe40a6b26a98b8f10d682e0e164633</originalsourceid><addsrcrecordid>eNqFkc1u1DAUhSMEokPhAdggCwlWBK5_cGJ26ailRSOxaCuWkce5AVeJHWxPh3mevmg9yogiJMTKZ_Gde6_PKYqXFN5TgOpDBGCyLrMslWCqhEfFggrOSsYZf1wsgEuRNeVHxbMYbwBoJUE-LY5ozZgQVb0o7hqyDDZZowfSOD3soo3E92SlJx18NH6yhjTThK5Dk_y4-0TO_Zac_powWHQGydamH4S-EwB_chYjaYbBb7EjF875W53sLZKrgDqN6BJJnpyg8SOSy6Rdp0NHrCOaXLvMhWjTLi-Kk016eF486fUQ8cXhPS6uz06vlufl6uvni2WzKo0QipeCrivRi55TKiouK1ZXYNAYVndVXYOSvOtRgJZrJrWq13VPoZM1Q0AqheT8uHg7z52C_7nBmNrRRoPDoB36TWylYoxSJjL4-i_wxm9CTi-2jCqVj4GPGaIzZHKOMWDfTsGOOuxaCu2-vnaur93LfX0tZM-rw-DNesTuwXHoKwNvDoCOubI-aGds_M0xEIoKKjOnZm5rB9z9f3P77cvlyRlwJfYxsNkbs819x_Dwu39ffg-DlcMa</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>219949305</pqid></control><display><type>article</type><title>A Critical Analysis of Laparoscopic Appendectomy: How Experience with 1,400 Appendectomies Allowed Innovative Treatment to Become Standard in a University Hospital</title><source>Wiley Online Library - AutoHoldings Journals</source><source>MEDLINE</source><source>SpringerLink Journals</source><creator>Schick, Kerstin S. ; Hüttl, Thomas P. ; Fertmann, Jan M. ; Hornung, Hans-Martin ; Jauch, Karl-Walter ; Hoffmann, Johannes N.</creator><creatorcontrib>Schick, Kerstin S. ; Hüttl, Thomas P. ; Fertmann, Jan M. ; Hornung, Hans-Martin ; Jauch, Karl-Walter ; Hoffmann, Johannes N.</creatorcontrib><description>Background
Although advantages of laparoscopic appendectomy (LA) have not yet been proved, there is increasing evidence that LA provides diagnostic and therapeutic advantages as compared to conventional surgery. This article reports the introduction of LA in a university hospital where LA now represents the standard operative procedure in patients with suspected appendicitis.
Methods
Consecutive patients with appendectomy were prospectively included in the surgical database from 5/1991 to 10/2005. Operating time skin-to-skin in minutes, conversion from laparoscopy to open appendectomy, and complications requiring reoperation as well as surgical expertise were recorded.
Results
After initial performance of LA by four experienced specialists in laparoscopic surgery between 1991 and 1994, LA was routinely implemented from 1995 to 2005. Laparoscopic appendectomy was performed in 1,012 patients, and conventional appendectomy in 449 patients, with a LA rate of about 90% in recent years. Intraoperative conversion was deemed necessary in 62 patients (6.2 %) by 40 surgeons among the 103 surgeons who performed LA over 14 years with a mean operative time of 57 ± 2 min. Between 1995 and 2005 about 25%–30% of LAs were performed as the first LA for the respective surgeon. Laparoscopic appendectomy was associated overall with a reduced length of stay in the hospital compared to open appendectomy (LA: 4.4 ± 0.1 days versus 6.6 ± 0.2 in open appendectomy;
p
< 0.001).
Conclusions
This analysis provides evidence that LA can be introduced in an university hospital with acceptable results despite low operation numbers per surgeon and a liberal teaching policy. The LA procedure, which is associated with a 2%–4% rate of reoperation, may serve as laparoscopy training for young surgeons.</description><identifier>ISSN: 0364-2313</identifier><identifier>EISSN: 1432-2323</identifier><identifier>DOI: 10.1007/s00268-007-9429-0</identifier><identifier>PMID: 18224478</identifier><identifier>CODEN: WJSUDI</identifier><language>eng</language><publisher>New York: Springer-Verlag</publisher><subject>Abdominal Surgery ; Appendectomy - methods ; Appendectomy - statistics & numerical data ; Appendicitis ; Appendicitis - surgery ; Biological and medical sciences ; Cardiac Surgery ; Digestive system. Abdomen ; Endoscopy ; General aspects ; General Surgery ; Hospitals, University ; Humans ; Investigative techniques, diagnostic techniques (general aspects) ; Laparoscopic Appendectomy ; Laparoscopic Group ; Laparoscopic Technique ; Laparoscopy - methods ; Laparoscopy - statistics & numerical data ; Medical sciences ; Medicine ; Medicine & Public Health ; Open Appendectomy ; Surgery ; Thoracic Surgery ; Vascular Surgery</subject><ispartof>World journal of surgery, 2008-07, Vol.32 (7), p.1406-1413</ispartof><rights>Société Internationale de Chirurgie 2008</rights><rights>2008 The Author(s) under exclusive licence to Société Internationale de Chirurgie</rights><rights>2008 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4493-41b74f4f311473672870cecc28d7880963dfe40a6b26a98b8f10d682e0e164633</citedby><cites>FETCH-LOGICAL-c4493-41b74f4f311473672870cecc28d7880963dfe40a6b26a98b8f10d682e0e164633</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00268-007-9429-0$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00268-007-9429-0$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,41488,42557,45574,45575,51319</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=20491416$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/18224478$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Schick, Kerstin S.</creatorcontrib><creatorcontrib>Hüttl, Thomas P.</creatorcontrib><creatorcontrib>Fertmann, Jan M.</creatorcontrib><creatorcontrib>Hornung, Hans-Martin</creatorcontrib><creatorcontrib>Jauch, Karl-Walter</creatorcontrib><creatorcontrib>Hoffmann, Johannes N.</creatorcontrib><title>A Critical Analysis of Laparoscopic Appendectomy: How Experience with 1,400 Appendectomies Allowed Innovative Treatment to Become Standard in a University Hospital</title><title>World journal of surgery</title><addtitle>World J Surg</addtitle><addtitle>World J Surg</addtitle><description>Background
Although advantages of laparoscopic appendectomy (LA) have not yet been proved, there is increasing evidence that LA provides diagnostic and therapeutic advantages as compared to conventional surgery. This article reports the introduction of LA in a university hospital where LA now represents the standard operative procedure in patients with suspected appendicitis.
Methods
Consecutive patients with appendectomy were prospectively included in the surgical database from 5/1991 to 10/2005. Operating time skin-to-skin in minutes, conversion from laparoscopy to open appendectomy, and complications requiring reoperation as well as surgical expertise were recorded.
Results
After initial performance of LA by four experienced specialists in laparoscopic surgery between 1991 and 1994, LA was routinely implemented from 1995 to 2005. Laparoscopic appendectomy was performed in 1,012 patients, and conventional appendectomy in 449 patients, with a LA rate of about 90% in recent years. Intraoperative conversion was deemed necessary in 62 patients (6.2 %) by 40 surgeons among the 103 surgeons who performed LA over 14 years with a mean operative time of 57 ± 2 min. Between 1995 and 2005 about 25%–30% of LAs were performed as the first LA for the respective surgeon. Laparoscopic appendectomy was associated overall with a reduced length of stay in the hospital compared to open appendectomy (LA: 4.4 ± 0.1 days versus 6.6 ± 0.2 in open appendectomy;
p
< 0.001).
Conclusions
This analysis provides evidence that LA can be introduced in an university hospital with acceptable results despite low operation numbers per surgeon and a liberal teaching policy. The LA procedure, which is associated with a 2%–4% rate of reoperation, may serve as laparoscopy training for young surgeons.</description><subject>Abdominal Surgery</subject><subject>Appendectomy - methods</subject><subject>Appendectomy - statistics & numerical data</subject><subject>Appendicitis</subject><subject>Appendicitis - surgery</subject><subject>Biological and medical sciences</subject><subject>Cardiac Surgery</subject><subject>Digestive system. Abdomen</subject><subject>Endoscopy</subject><subject>General aspects</subject><subject>General Surgery</subject><subject>Hospitals, University</subject><subject>Humans</subject><subject>Investigative techniques, diagnostic techniques (general aspects)</subject><subject>Laparoscopic Appendectomy</subject><subject>Laparoscopic Group</subject><subject>Laparoscopic Technique</subject><subject>Laparoscopy - methods</subject><subject>Laparoscopy - statistics & numerical data</subject><subject>Medical sciences</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Open Appendectomy</subject><subject>Surgery</subject><subject>Thoracic Surgery</subject><subject>Vascular Surgery</subject><issn>0364-2313</issn><issn>1432-2323</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2008</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNqFkc1u1DAUhSMEokPhAdggCwlWBK5_cGJ26ailRSOxaCuWkce5AVeJHWxPh3mevmg9yogiJMTKZ_Gde6_PKYqXFN5TgOpDBGCyLrMslWCqhEfFggrOSsYZf1wsgEuRNeVHxbMYbwBoJUE-LY5ozZgQVb0o7hqyDDZZowfSOD3soo3E92SlJx18NH6yhjTThK5Dk_y4-0TO_Zac_powWHQGydamH4S-EwB_chYjaYbBb7EjF875W53sLZKrgDqN6BJJnpyg8SOSy6Rdp0NHrCOaXLvMhWjTLi-Kk016eF486fUQ8cXhPS6uz06vlufl6uvni2WzKo0QipeCrivRi55TKiouK1ZXYNAYVndVXYOSvOtRgJZrJrWq13VPoZM1Q0AqheT8uHg7z52C_7nBmNrRRoPDoB36TWylYoxSJjL4-i_wxm9CTi-2jCqVj4GPGaIzZHKOMWDfTsGOOuxaCu2-vnaur93LfX0tZM-rw-DNesTuwXHoKwNvDoCOubI-aGds_M0xEIoKKjOnZm5rB9z9f3P77cvlyRlwJfYxsNkbs819x_Dwu39ffg-DlcMa</recordid><startdate>200807</startdate><enddate>200807</enddate><creator>Schick, Kerstin S.</creator><creator>Hüttl, Thomas P.</creator><creator>Fertmann, Jan M.</creator><creator>Hornung, Hans-Martin</creator><creator>Jauch, Karl-Walter</creator><creator>Hoffmann, Johannes N.</creator><general>Springer-Verlag</general><general>Springer‐Verlag</general><general>Springer</general><general>Springer Nature B.V</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7T5</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>200807</creationdate><title>A Critical Analysis of Laparoscopic Appendectomy: How Experience with 1,400 Appendectomies Allowed Innovative Treatment to Become Standard in a University Hospital</title><author>Schick, Kerstin S. ; Hüttl, Thomas P. ; Fertmann, Jan M. ; Hornung, Hans-Martin ; Jauch, Karl-Walter ; Hoffmann, Johannes N.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4493-41b74f4f311473672870cecc28d7880963dfe40a6b26a98b8f10d682e0e164633</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2008</creationdate><topic>Abdominal Surgery</topic><topic>Appendectomy - methods</topic><topic>Appendectomy - statistics & numerical data</topic><topic>Appendicitis</topic><topic>Appendicitis - surgery</topic><topic>Biological and medical sciences</topic><topic>Cardiac Surgery</topic><topic>Digestive system. Abdomen</topic><topic>Endoscopy</topic><topic>General aspects</topic><topic>General Surgery</topic><topic>Hospitals, University</topic><topic>Humans</topic><topic>Investigative techniques, diagnostic techniques (general aspects)</topic><topic>Laparoscopic Appendectomy</topic><topic>Laparoscopic Group</topic><topic>Laparoscopic Technique</topic><topic>Laparoscopy - methods</topic><topic>Laparoscopy - statistics & numerical data</topic><topic>Medical sciences</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Open Appendectomy</topic><topic>Surgery</topic><topic>Thoracic Surgery</topic><topic>Vascular Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Schick, Kerstin S.</creatorcontrib><creatorcontrib>Hüttl, Thomas P.</creatorcontrib><creatorcontrib>Fertmann, Jan M.</creatorcontrib><creatorcontrib>Hornung, Hans-Martin</creatorcontrib><creatorcontrib>Jauch, Karl-Walter</creatorcontrib><creatorcontrib>Hoffmann, Johannes N.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Immunology Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>World journal of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Schick, Kerstin S.</au><au>Hüttl, Thomas P.</au><au>Fertmann, Jan M.</au><au>Hornung, Hans-Martin</au><au>Jauch, Karl-Walter</au><au>Hoffmann, Johannes N.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A Critical Analysis of Laparoscopic Appendectomy: How Experience with 1,400 Appendectomies Allowed Innovative Treatment to Become Standard in a University Hospital</atitle><jtitle>World journal of surgery</jtitle><stitle>World J Surg</stitle><addtitle>World J Surg</addtitle><date>2008-07</date><risdate>2008</risdate><volume>32</volume><issue>7</issue><spage>1406</spage><epage>1413</epage><pages>1406-1413</pages><issn>0364-2313</issn><eissn>1432-2323</eissn><coden>WJSUDI</coden><abstract>Background
Although advantages of laparoscopic appendectomy (LA) have not yet been proved, there is increasing evidence that LA provides diagnostic and therapeutic advantages as compared to conventional surgery. This article reports the introduction of LA in a university hospital where LA now represents the standard operative procedure in patients with suspected appendicitis.
Methods
Consecutive patients with appendectomy were prospectively included in the surgical database from 5/1991 to 10/2005. Operating time skin-to-skin in minutes, conversion from laparoscopy to open appendectomy, and complications requiring reoperation as well as surgical expertise were recorded.
Results
After initial performance of LA by four experienced specialists in laparoscopic surgery between 1991 and 1994, LA was routinely implemented from 1995 to 2005. Laparoscopic appendectomy was performed in 1,012 patients, and conventional appendectomy in 449 patients, with a LA rate of about 90% in recent years. Intraoperative conversion was deemed necessary in 62 patients (6.2 %) by 40 surgeons among the 103 surgeons who performed LA over 14 years with a mean operative time of 57 ± 2 min. Between 1995 and 2005 about 25%–30% of LAs were performed as the first LA for the respective surgeon. Laparoscopic appendectomy was associated overall with a reduced length of stay in the hospital compared to open appendectomy (LA: 4.4 ± 0.1 days versus 6.6 ± 0.2 in open appendectomy;
p
< 0.001).
Conclusions
This analysis provides evidence that LA can be introduced in an university hospital with acceptable results despite low operation numbers per surgeon and a liberal teaching policy. The LA procedure, which is associated with a 2%–4% rate of reoperation, may serve as laparoscopy training for young surgeons.</abstract><cop>New York</cop><pub>Springer-Verlag</pub><pmid>18224478</pmid><doi>10.1007/s00268-007-9429-0</doi><tpages>8</tpages></addata></record> |
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| source | Wiley Online Library - AutoHoldings Journals; MEDLINE; SpringerLink Journals |
| subjects | Abdominal Surgery Appendectomy - methods Appendectomy - statistics & numerical data Appendicitis Appendicitis - surgery Biological and medical sciences Cardiac Surgery Digestive system. Abdomen Endoscopy General aspects General Surgery Hospitals, University Humans Investigative techniques, diagnostic techniques (general aspects) Laparoscopic Appendectomy Laparoscopic Group Laparoscopic Technique Laparoscopy - methods Laparoscopy - statistics & numerical data Medical sciences Medicine Medicine & Public Health Open Appendectomy Surgery Thoracic Surgery Vascular Surgery |
| title | A Critical Analysis of Laparoscopic Appendectomy: How Experience with 1,400 Appendectomies Allowed Innovative Treatment to Become Standard in a University Hospital |
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