WOFAPS 2025 8th World Congress of Pediatric Surgery

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Oral Presentation - 66

Optimal laparoscopic approach for surgical residents: comparison of three different techniques in pediatric appendectomy

Lynne Takada 1, Toshio Harumatsu 1, Koshiro Sugita 1, Ayaka Nagano 1, Yumiko Tabata 2, Yumiko Iwamoto 1, Nanako Nishida 1, Chihiro Kedoin 1, Yudai Tsuruno 1, Keisuke Yano 1, Shun Onishi 1, Takafumi Kawano 1, Motofumi Torikai 2, Satoshi Ieiri 1
1 Department of Pediatric Surgery, Kagoshima University
2 Department of Pediatric Surgery, Kagoshima City Hospital

Purpose: Laparoscopic appendectomy (LA) is suitable for laparoscopic training of junior surgical residents because of the difficulty level of the surgical procedure. However, to improve trocars have been reduced in size relative to those used in conventional LA, increasing the difficulty level of the surgical procedure for surgical residents. We aimed to compare surgical outcomes and educational values among the three laparoscopic approaches for pediatric LA performed by junior surgical residents.

Method: We retrospectively reviewed 367 patients who underwent LA at two institutions from 2016 to 2024, categorized into conventional three-port (CTPLA), two-site (TSLA), and transumbilical laparoscopy-assisted appendectomy (TULAA) groups. TULAA involves exteriorization of the appendix through the umbilical incision. We reviewed medical records to analyze surgical outcomes, comparing the three surgical procedures in patients with simple and complicated appendicitis.

Results: For simple appendicitis (TULAA, n=89; TSLA, n=79; CTPLA, n=45), TULAA showed significantly shorter operative time (56.5 ± 19.6 min) compared to TSLA (88.0 ± 32.9) and CTPLA (68.6 ± 13.9) (p<0.001). Pneumoperitoneum time was also significantly reduced with TULAA. Postoperative hospital stay was also significantly shorter in TULAA (3.9 ± 0.3 days) than in TSLA (5.8 ± 2.7) (p<0.001). For complicated appendicitis (TULAA, n=51; TSLA, n=72; CTPLA, n=31), TULAA demonstrated significantly shorter operative time (83.1 ± 35.1 min vs. 104.5 ± 38.8 vs. 89.1 ± 25.7, p<0.05). Postoperative hospital stay was significantly shorter in CTPLA (6.3 ± 1.9 days) compared to TSLA (9.8 ± 4.6) (p<0.01). No significant differences in perioperative complications were observed among the three approaches.

Conclusion: TULAA showed favorable outcomes as an ideal initial approach for surgical training. Sequential transition to TSLA enables surgical residents to develop advanced laparoscopic skills.

Keywords: appendicitis, pediatric patients, laparoscopic surgery, surgical residents

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