Training in basic laparoscopic technique and implementation of diagnostic laparoscopy

INTRODUCTION: Diagnostic laparoscopy (DL) is performed when the clinical diagnosis is acute appendicitis. Upon the perioperative diagnosis of appendicitis, laparoscopic appendectomy (LA) is performed. The aim of this study was to monitor the general implementation of a surgical procedure not previously universally utilized for this operative indication and determine whether DL was suitable for training basic laparoscopic abilities. METHODS: After discussing the relevant literature, surgical technique and aim and design of the study, DL was introduced. In the period 1 September 2002 to 1 March 2004, 100 patients with the diagnosis of acute appendicitis were included in the study. RESULTS: Out of the 19 residents included in the study, 14 performed DL, with 9 also performing LA. The percentage of DL increased to 66% during the study period. After an average of two supervised DLs, the surgeons were able to perform DL without supervision. Supervision was done primarily by the attending surgeons. Of the 100 patients operated on, 63 underwent appendectomy; 39 were performed laparoscopically and 24 were done by conventional appendectomy preceded by DL. Postoperative complications occurred in five patients in the OA group, three in the LA group and none in the DL group. The operative time was comparable with that published in the literature. The perioperative diagnosis of appendicitis was confirmed histologically in 92% of the cases. DISCUSSION: DL had a short learning curve. The surgeons were able to make a correct diagnosis laparoscopically. Supervision was performed primarily by attending surgeons. It is concluded that DL is suitable for training basic laparoscopic skills.