The advent of high definition video-laparoscopy has transformed the laparoscopic appendectomy into an elegant, reliable procedure which can be easily performed.
In most cases it can be completed within 20 to 30 minutes, and with experience, all clinical settings can be mastered. Critics of this procedure have claimed there are no significant cost savings and no improvement in the recovery of the patient.
The following results will disprove these claims. This procedure remains invaluable in patients with undiagnosed abdominal pain requiring further diagnostic intra-abdominal exploration as well as patients with perforated appendicitis with or without an intra-abdominal abscess.
In addition, this technique truly makes the simple appendectomy an outpatient procedure. The patient can resume a diet within a few hours after the "lap-appy" and in most cases can be discharged within 24 to 36 hours.
The indications for a laparoscopic appendectomy are simple. Any patient suspected to have an acute appendicitis should undergo a laparoscopic appendectomy. As our laparoscopic skills have dramatically improved over the past decade, we now rarely schedule a patient to undergo an "open" appendectomy.
In addition, all surgeons are now well aware that the introduction of spiral computerized tomography has significantly impacted the diagnostic management of these patients. In selected clinical settings, careful use of this imaging modality will improve the diagnostic acumen of the clinician beyond the 95 percentile.
The procedures for which we have used minimally invasive techniques include:
- cholecystectomy (removal of the gall bladder)
- diagnostic laparoscopy for chronic abdominal pain
- pull-through procedures for Hirschsprung's disease
- tumor biopsy
- pectus excavatum repair
- treatment of empyema (infection in the chest) and pneumothorax (air trapped in the chest) and others.
Advances in video technology have enabled surgeons to perform complex procedures without the traditional unsightly and painful incisions of the past. The use of Minimal Access techniques or "Nintendo Surgery" in infants and children requires surgical and anesthetic expertise, as well as instruments specifically made for conditions common in infants and children.
The Division of Pediatric Surgery at the Babies & Children's Hospital launched the first video-assisted surgical program in the Tri-State area dedicated exclusively for children. During the last 4 years, we have performed more than 300 Minimal Access procedures have on infants and children, from the newborn period through adolescence, with a dramatic reduction in hospital stay and need for postoperative narcotics. We have used Minimal Access techniques for both diagnostic and therapeutic procedures.
These have included correction of acute appendicitis, pyloric stenosis, colon pull-through procedures, removal of the spleen and gall bladder, undescended testis and varicocele, ovarian cysts, abdominal and chest tumor biopsy and staging, drainage of serious chest infection after pneumonia, insertion of dialysis and shunt tubes, and treatment of children with chronic lower abdominal pain.
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