**Part 3**

**Laparoscopic Appendectomy** 

112 Updated Topics in Minimally Invasive Abdominal Surgery

[101] Reed AB, Crafton C, Giglia JS, Hutto JD. Back to basics: use of fresh cadavers in

[102] Katz R, Hoznek A, Antiphon P, Van VR, Delmas V, Abbou CC. Cadaveric versus porcine models in urological laparoscopic training. *Urol Int* 2003; 71(3):310-315. [103] Cundiff GW, Weidner AC, Visco AG. Effectiveness of laparoscopic cadaveric

dissection in enhancing resident comprehension of pelvic anatomy. *J Am Coll Surg*

vascular surgery training. *Surgery* 2009; 146(4):757-762.

2001; 192(4):492-497.

**8** 

*Greece* 

**Laparoscopic Appendectomy** 

*Department of Surgery, Athens Medical Center* 

Konstantinos M. Konstantinidis and Kornilia A. Anastasakou

Suspected acute appendicitis is the most frequent cause of emergency operations in visceral surgery worldwide. Acute appendicitis is the reason for most urgent admissions and unscheduled operations in general surgery. In the western world approximately 8% of the population are appendectomised (Addis et al., 1990). The treatment for acute appendicitis has been conventional appendectomy for more than a century. This procedure proved to be safe and effective. However, a problem that remained is the high percentage -up to 47% in women of child-bearing age- of negative appendectomies (Borgstein et. al, 1997). Laparoscopic appendectomy counts almost 30 years of presence, and its introduction has met with more hurdles than that of laparoscopic cholecystectomy. Especially during the last two decades numerous studies tried to define the role of laparoscopic appendectomy in the treatment of suspected acute appendicitis. In this chapter we aim to present our experience with the laparoscopic approach for suspected appendicitis during the last almost twenty years and discuss the diagnostic and therapeutic effects of laparoscopy in suspected appendicitis. We will present our diagnostic approach, our surgical technique, and our results, and will discuss the literature. The role of laparoscopy in fertile females will be analysed. Also the place of laparoscopy in special groups such as the elderly, the employed patients, the obese patients, the pregnant women, and the children will be discussed. Finally we will refer briefly to newer techniques including the single port laparoscopic appendectomy, the needlescopic procedure, and the incidental robotic appendectomy.

 Since the introduction of endoscopic appendectomy by Kurt Semm in 1983 (Semm, 1983) the surgical community tried to determine its advantages and disadvantages compared to the open procedure. Especially during the last twenty years there have been over 60 randomized controlled trials comparing laparoscopic and open appendectomy in adults (Vettoretto et al., 2010) as well as many meta-analyses of randomized controlled trials (Bennett et al., 2007; Chung et al, 1999; Fingerhut et al., 1999; Garbutt et al., 1999; Golub et al., 1998; Liu et al., 2010; Sauerland et al., 1998, 2002, 2004, 2010). The number of publications on laparoscopic appendectomy is still increasing, while publications on laparoscopic cholecystectomy decline. The latter shows that the laparoscopic approach in suspected acute appendicitis has not yet been fully accepted as the gold standard. There are still open issues regarding the laparoscopic approach. These have to do with the indications, the results, the

**1. Introduction** 

**1.1 Background 1.1.1 Literature** 
