Challenges to implement laparoscopic appendectomy as the first-line treatment for acute appendicitis: a fifteen-year experience in a tertiary hospital in Brazil
the barriers to implement emergency laparoscopy in public teaching hospitals involve issues such as resident learning curves and resource costs and availability. This study was designed to describe the issues facing the implementation of laparoscopic approach for acute appendicitis over 15 years in...
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| Veröffentlicht in: | Revista do Colegio Brasileiro de Cirurgioes 2023, Vol.50, p.e20233527 |
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| creator | Damous, Sergio Henrique Bastos Menegozzo, Carlos Augusto Metidieri Rocha, Marcelo Cristiano Collet-E-Silva, Francisco Salles Utiyama, Edivaldo Massazo |
| description | the barriers to implement emergency laparoscopy in public teaching hospitals involve issues such as resident learning curves and resource costs and availability. This study was designed to describe the issues facing the implementation of laparoscopic approach for acute appendicitis over 15 years in a single academic center in Brazil.
retrospective study of patients undergoing emergency appendectomy from 2004 to 2018. Clinical data were compared to four major actions implemented in the emergency surgical service: minimally invasive surgery training for residents (2007), laparoscopic stump closure using metal clips (2008), 24/7 availability of laparoscopic instruments for emergency surgeries (2010), and third-party contract for maintenance of the laparoscopic instruments and implementation of polymeric clips for stump closure (2013). We evaluated the increase in laparoscopic appendectomy after the implementation of those major changes.
we identified 1168 appendectomies during the study period, of which 691 (59%), 465 (40%), and 12 (1%) were open, laparoscopic, and converted, respectively. The implementation of the major changes since 2004 resulted in an increase of laparoscopic appendectomies from 11% in 2007 to 80% in 2016. These actions were decisive in the widespread use of laparoscopy for acute appendicitis (p |
| doi_str_mv | 10.1590/0100-6991e-20233527-en |
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retrospective study of patients undergoing emergency appendectomy from 2004 to 2018. Clinical data were compared to four major actions implemented in the emergency surgical service: minimally invasive surgery training for residents (2007), laparoscopic stump closure using metal clips (2008), 24/7 availability of laparoscopic instruments for emergency surgeries (2010), and third-party contract for maintenance of the laparoscopic instruments and implementation of polymeric clips for stump closure (2013). We evaluated the increase in laparoscopic appendectomy after the implementation of those major changes.
we identified 1168 appendectomies during the study period, of which 691 (59%), 465 (40%), and 12 (1%) were open, laparoscopic, and converted, respectively. The implementation of the major changes since 2004 resulted in an increase of laparoscopic appendectomies from 11% in 2007 to 80% in 2016. These actions were decisive in the widespread use of laparoscopy for acute appendicitis (p<0.001). The standardization of the hem-o-lok clip in the treatment of the appendiceal stump made the procedure more feasible, reducing the surgical time using laparoscopic access and increasing the team's adherence, so that this became the route of choice in about 85% of cases in the period from 2014 to 2018, 80% performed by 3rd year resident physicians. No intraoperative complications were noted related to laparoscopic access, even in more complicated appendicitis. There was no mortality reported, no reoperations or readmissions to hospital during a 30-day postoperative period.
the development of a feasible, reproducible, and safe technical standardization, associated with continuous cost optimization, are the cornerstones for a consistent and viable change in the current practice for appendectomies in middle and lower-income countries.</description><identifier>ISSN: 0100-6991</identifier><identifier>EISSN: 1809-4546</identifier><identifier>DOI: 10.1590/0100-6991e-20233527-en</identifier><identifier>PMID: 37222347</identifier><language>eng</language><publisher>Brazil: Colégio Brasileiro de Cirurgiões</publisher><subject>Acute Disease ; Appendectomy ; Appendicitis ; Brazil ; Education ; Humans ; Laparoscopic Appendectomy ; Laparoscopy ; Medical Education ; Retrospective Studies ; Tertiary Care Centers</subject><ispartof>Revista do Colegio Brasileiro de Cirurgioes, 2023, Vol.50, p.e20233527</ispartof><rights>2023 Revista do Colégio Brasileiro de Cirurgiões 2023</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c382n-9ca47e5dcd666b2cb5e00983332204b0dfdfe0ce3a1c634d785818de9ee9f30a3</cites><orcidid>0000-0003-1374-225X ; 0000-0001-8756-5992 ; 0000-0001-6821-2286 ; 0000-0002-8453-7184 ; 0000-0003-3572-8977</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10508672/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10508672/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,4022,27922,27923,27924,53790,53792</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37222347$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Damous, Sergio Henrique Bastos</creatorcontrib><creatorcontrib>Menegozzo, Carlos Augusto Metidieri</creatorcontrib><creatorcontrib>Rocha, Marcelo Cristiano</creatorcontrib><creatorcontrib>Collet-E-Silva, Francisco Salles</creatorcontrib><creatorcontrib>Utiyama, Edivaldo Massazo</creatorcontrib><title>Challenges to implement laparoscopic appendectomy as the first-line treatment for acute appendicitis: a fifteen-year experience in a tertiary hospital in Brazil</title><title>Revista do Colegio Brasileiro de Cirurgioes</title><addtitle>Rev Col Bras Cir</addtitle><description>the barriers to implement emergency laparoscopy in public teaching hospitals involve issues such as resident learning curves and resource costs and availability. This study was designed to describe the issues facing the implementation of laparoscopic approach for acute appendicitis over 15 years in a single academic center in Brazil.
retrospective study of patients undergoing emergency appendectomy from 2004 to 2018. Clinical data were compared to four major actions implemented in the emergency surgical service: minimally invasive surgery training for residents (2007), laparoscopic stump closure using metal clips (2008), 24/7 availability of laparoscopic instruments for emergency surgeries (2010), and third-party contract for maintenance of the laparoscopic instruments and implementation of polymeric clips for stump closure (2013). We evaluated the increase in laparoscopic appendectomy after the implementation of those major changes.
we identified 1168 appendectomies during the study period, of which 691 (59%), 465 (40%), and 12 (1%) were open, laparoscopic, and converted, respectively. The implementation of the major changes since 2004 resulted in an increase of laparoscopic appendectomies from 11% in 2007 to 80% in 2016. These actions were decisive in the widespread use of laparoscopy for acute appendicitis (p<0.001). The standardization of the hem-o-lok clip in the treatment of the appendiceal stump made the procedure more feasible, reducing the surgical time using laparoscopic access and increasing the team's adherence, so that this became the route of choice in about 85% of cases in the period from 2014 to 2018, 80% performed by 3rd year resident physicians. No intraoperative complications were noted related to laparoscopic access, even in more complicated appendicitis. There was no mortality reported, no reoperations or readmissions to hospital during a 30-day postoperative period.
the development of a feasible, reproducible, and safe technical standardization, associated with continuous cost optimization, are the cornerstones for a consistent and viable change in the current practice for appendectomies in middle and lower-income countries.</description><subject>Acute Disease</subject><subject>Appendectomy</subject><subject>Appendicitis</subject><subject>Brazil</subject><subject>Education</subject><subject>Humans</subject><subject>Laparoscopic Appendectomy</subject><subject>Laparoscopy</subject><subject>Medical Education</subject><subject>Retrospective Studies</subject><subject>Tertiary Care Centers</subject><issn>0100-6991</issn><issn>1809-4546</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>DOA</sourceid><recordid>eNpVkt1uEzEQhVcIREPhFSq_wIL_1l5zgyCCtlIlbuDamtjjxNWud-V1EeFpeFScpI3olaWZcz6PZk7TXDH6nnWGfqCM0lYZw7DllAvRcd1ietGsWE9NKzupXjars-iiebMs95RKwYx43VwIzTkXUq-av-sdDAOmLS6kTCSO84AjpkIGmCFPi5vm6AjMMyaPrkzjnkBV7pCEmJfSDjEhKRmhHF1hygTcQ8FHS3SxxOUjgSoPBTG1e4RM8PeMOWJySGKqzYK5RMh7spuWORYYDuUvGf7E4W3zKsCw4LvH97L5-e3rj_VNe_f9-nb9-a51ouepNQ6kxs47r5TacLfpkFLTCyE4p3JDffABqUMBzCkhve67nvUeDaIJgoK4bG5PXD_BvZ1zHOs8doJoj4Upby3UId2AtlMKqdHa0N7L0NFeaFCCIe80D1K6yvp0Ys0PmxG9q5vJMDyDPu-kuLPb6ZdltNKU5pWgTgRXb7BkDGczo_YQAHu4rT0GwD4FwGKqxqv_vz7bni4u_gEvT7Gz</recordid><startdate>2023</startdate><enddate>2023</enddate><creator>Damous, Sergio Henrique Bastos</creator><creator>Menegozzo, Carlos Augusto Metidieri</creator><creator>Rocha, Marcelo Cristiano</creator><creator>Collet-E-Silva, Francisco Salles</creator><creator>Utiyama, Edivaldo Massazo</creator><general>Colégio Brasileiro de Cirurgiões</general><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>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0003-1374-225X</orcidid><orcidid>https://orcid.org/0000-0001-8756-5992</orcidid><orcidid>https://orcid.org/0000-0001-6821-2286</orcidid><orcidid>https://orcid.org/0000-0002-8453-7184</orcidid><orcidid>https://orcid.org/0000-0003-3572-8977</orcidid></search><sort><creationdate>2023</creationdate><title>Challenges to implement laparoscopic appendectomy as the first-line treatment for acute appendicitis: a fifteen-year experience in a tertiary hospital in Brazil</title><author>Damous, Sergio Henrique Bastos ; Menegozzo, Carlos Augusto Metidieri ; Rocha, Marcelo Cristiano ; Collet-E-Silva, Francisco Salles ; Utiyama, Edivaldo Massazo</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c382n-9ca47e5dcd666b2cb5e00983332204b0dfdfe0ce3a1c634d785818de9ee9f30a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Acute Disease</topic><topic>Appendectomy</topic><topic>Appendicitis</topic><topic>Brazil</topic><topic>Education</topic><topic>Humans</topic><topic>Laparoscopic Appendectomy</topic><topic>Laparoscopy</topic><topic>Medical Education</topic><topic>Retrospective Studies</topic><topic>Tertiary Care Centers</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Damous, Sergio Henrique Bastos</creatorcontrib><creatorcontrib>Menegozzo, Carlos Augusto Metidieri</creatorcontrib><creatorcontrib>Rocha, Marcelo Cristiano</creatorcontrib><creatorcontrib>Collet-E-Silva, Francisco Salles</creatorcontrib><creatorcontrib>Utiyama, Edivaldo Massazo</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>Revista do Colegio Brasileiro de Cirurgioes</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Damous, Sergio Henrique Bastos</au><au>Menegozzo, Carlos Augusto Metidieri</au><au>Rocha, Marcelo Cristiano</au><au>Collet-E-Silva, Francisco Salles</au><au>Utiyama, Edivaldo Massazo</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Challenges to implement laparoscopic appendectomy as the first-line treatment for acute appendicitis: a fifteen-year experience in a tertiary hospital in Brazil</atitle><jtitle>Revista do Colegio Brasileiro de Cirurgioes</jtitle><addtitle>Rev Col Bras Cir</addtitle><date>2023</date><risdate>2023</risdate><volume>50</volume><spage>e20233527</spage><pages>e20233527-</pages><issn>0100-6991</issn><eissn>1809-4546</eissn><abstract>the barriers to implement emergency laparoscopy in public teaching hospitals involve issues such as resident learning curves and resource costs and availability. This study was designed to describe the issues facing the implementation of laparoscopic approach for acute appendicitis over 15 years in a single academic center in Brazil.
retrospective study of patients undergoing emergency appendectomy from 2004 to 2018. Clinical data were compared to four major actions implemented in the emergency surgical service: minimally invasive surgery training for residents (2007), laparoscopic stump closure using metal clips (2008), 24/7 availability of laparoscopic instruments for emergency surgeries (2010), and third-party contract for maintenance of the laparoscopic instruments and implementation of polymeric clips for stump closure (2013). We evaluated the increase in laparoscopic appendectomy after the implementation of those major changes.
we identified 1168 appendectomies during the study period, of which 691 (59%), 465 (40%), and 12 (1%) were open, laparoscopic, and converted, respectively. The implementation of the major changes since 2004 resulted in an increase of laparoscopic appendectomies from 11% in 2007 to 80% in 2016. These actions were decisive in the widespread use of laparoscopy for acute appendicitis (p<0.001). The standardization of the hem-o-lok clip in the treatment of the appendiceal stump made the procedure more feasible, reducing the surgical time using laparoscopic access and increasing the team's adherence, so that this became the route of choice in about 85% of cases in the period from 2014 to 2018, 80% performed by 3rd year resident physicians. No intraoperative complications were noted related to laparoscopic access, even in more complicated appendicitis. There was no mortality reported, no reoperations or readmissions to hospital during a 30-day postoperative period.
the development of a feasible, reproducible, and safe technical standardization, associated with continuous cost optimization, are the cornerstones for a consistent and viable change in the current practice for appendectomies in middle and lower-income countries.</abstract><cop>Brazil</cop><pub>Colégio Brasileiro de Cirurgiões</pub><pmid>37222347</pmid><doi>10.1590/0100-6991e-20233527-en</doi><orcidid>https://orcid.org/0000-0003-1374-225X</orcidid><orcidid>https://orcid.org/0000-0001-8756-5992</orcidid><orcidid>https://orcid.org/0000-0001-6821-2286</orcidid><orcidid>https://orcid.org/0000-0002-8453-7184</orcidid><orcidid>https://orcid.org/0000-0003-3572-8977</orcidid><oa>free_for_read</oa></addata></record> |
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| identifier | ISSN: 0100-6991 |
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| source | MEDLINE; DOAJ Directory of Open Access Journals; PubMed Central Open Access; EZB-FREE-00999 freely available EZB journals; PubMed Central |
| subjects | Acute Disease Appendectomy Appendicitis Brazil Education Humans Laparoscopic Appendectomy Laparoscopy Medical Education Retrospective Studies Tertiary Care Centers |
| title | Challenges to implement laparoscopic appendectomy as the first-line treatment for acute appendicitis: a fifteen-year experience in a tertiary hospital in Brazil |
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