Our Summary

This research paper looked at whether training in minimally invasive surgery (MIS) improves outcomes in a common procedure called laparoscopic appendectomy (a minimally invasive surgery to remove the appendix). To do this, the researchers reviewed the cases of all patients who underwent this procedure for suspected acute appendicitis between 2014 and 2015 at a single medical center. They compared the results of surgeries performed by surgeons trained in MIS to those performed by general surgeons.

The study included 507 patients in total: 181 who were operated on by MIS-trained surgeons and 326 who were operated on by general surgeons. The researchers found no significant differences in patient demographics or medical histories between the two groups.

However, they found that surgeries performed by MIS-trained surgeons were significantly shorter in duration and had fewer intra-operative (during surgery) complications. The number of post-operative (after surgery) complications was similar between the two groups.

In the MIS group, the researchers also compared surgeries that used a single incision versus multiple incisions and found no differences in complications during or after surgery.

The research concluded that MIS training improves operative metrics (like duration of surgery) and patient outcomes even in basic laparoscopic procedures.

FAQs

  1. Does training in minimally invasive surgery improve outcomes in laparoscopic appendectomy?
  2. Are there any differences in complications during or after surgery between surgeries performed with single or multiple incisions?
  3. What differences were found between surgeries performed by MIS-trained surgeons and general surgeons in the study?

Doctor’s Tip

A helpful tip a doctor might tell a patient about appendectomy is that undergoing minimally invasive surgery (MIS) for the procedure can lead to shorter surgery duration and fewer complications compared to traditional surgery. Patients may want to seek out a surgeon who has specific training in MIS to improve their outcomes.

Suitable For

Patients who are typically recommended for appendectomy include those with suspected acute appendicitis, which is characterized by symptoms such as abdominal pain, fever, nausea, and vomiting. Surgical removal of the appendix is often recommended to prevent complications such as appendiceal rupture and peritonitis.

In this study, patients who underwent laparoscopic appendectomy for suspected acute appendicitis were included, regardless of their age or medical history. The study found that training in MIS significantly improved outcomes in terms of shorter surgery duration and fewer intra-operative complications.

Overall, patients who are in good general health and have symptoms of acute appendicitis are typically recommended for appendectomy. Minimally invasive surgery techniques, such as laparoscopic appendectomy, are increasingly being used as they offer benefits such as shorter recovery times, less pain, and lower risk of complications compared to traditional open surgery.

Timeline

Timeline of a patient’s experience before and after appendectomy:

Before appendectomy:

  1. Patient experiences symptoms of appendicitis such as abdominal pain, nausea, vomiting, and fever.
  2. Patient visits a healthcare provider who conducts a physical examination and possibly orders blood tests and imaging studies to confirm the diagnosis.
  3. Patient is scheduled for surgery and instructed on preoperative preparations such as fasting and stopping certain medications.

During appendectomy:

  1. Patient undergoes laparoscopic appendectomy, which involves making small incisions in the abdomen to remove the inflamed appendix.
  2. Surgery is performed by either a general surgeon or a surgeon trained in minimally invasive surgery.
  3. Surgery typically lasts for a shorter duration if performed by a MIS-trained surgeon.

After appendectomy:

  1. Patient is monitored in the recovery room for a few hours post-surgery.
  2. Patient may experience some pain and discomfort at the incision sites.
  3. Patient is discharged from the hospital within a day or two after surgery.
  4. Patient is advised to rest and avoid strenuous activities for a few weeks.
  5. Patient may experience post-operative complications such as infection or bowel obstruction, although the risk is similar between surgeries performed by MIS-trained surgeons and general surgeons.
  6. Patient follows up with their healthcare provider for a post-operative check-up to ensure proper healing.

Overall, the study suggests that MIS training can improve operative metrics and patient outcomes in laparoscopic appendectomy procedures.

What to Ask Your Doctor

Some questions a patient should ask their doctor about appendectomy include:

  1. What type of procedure (laparoscopic or open) will be used for my appendectomy?
  2. Are you trained in minimally invasive surgery (MIS) and if so, how does that training affect the outcome of the surgery?
  3. How long will the surgery take?
  4. What are the potential complications during and after the surgery?
  5. Will I need to stay in the hospital after the surgery, and if so, for how long?
  6. What is the expected recovery time and when can I return to normal activities?
  7. Are there any specific dietary restrictions or guidelines I should follow after the surgery?
  8. What are the signs of infection or other complications that I should watch for after the surgery?
  9. Will I need any follow-up appointments or tests after the surgery?
  10. Are there any long-term effects or risks associated with having an appendectomy?

Reference

Authors: Gray KD, Burshtein JG, Obeid L, Moore MD, Dakin G, Pomp A, Afaneh C. Journal: World J Surg. 2018 Jun;42(6):1706-1713. doi: 10.1007/s00268-017-4374-z. PMID: 29143092