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My dear colleagues
of the Spanish Society of Surgical Endoscopy, it is my great privilege
and honor to contribute to the first edition of your magazine.
I performed the first endoscopic Appendectomy on May 30, 1980 at
Kiel University Hospital in Germany. The original technique with
Z suture closure according to
Mc Burney and Sprengel was used in this operation. I used this technique
as it was the classic method being used in Germany at that time.
Although this was a time consuming method, I felt forced to use
this method as I was performing this endoscopic operation for the
first time ever in the world. I endured much criticism for this
procedure and was nearly dismissed as head of department. When trying
to publish this case I actually received a letter of rejection from
one journal saying, “This journal would make itself look ridiculous
to publish such nonsense.” Consequently, it took two years
By the early 1990’s, as laparoscopic surgery became accepted
in general surgery, I
replaced my original technique with an easier one using a loop ligation.
The results of the endoscopic appendectomy using loop ligation leaving
the stump exposed were the same, as when the Z suture closure was
used to invaginate the stump. The significance of this was a decrease
in surgery time of 50 %.
When the appendix is situated in the Orthrograde position, a coagulation
temperature of 110 degrees is recommended (diagram 1.2 A –
Using high frequency current for coagulation is shown in diagram
1.3 A - F.
The danger is to coagulate the coecumpol which may cause complications
(e.g. pain and bowel perforation.) The retrograde position is shown
in Fig. Tab 3 (A-E), it is better to use the endocoagulator set
at 120 degrees Fahrenheit rather then the high frequency current
modalities. The illustration in 2 D shows the extreme situation
in retrograde cases whereby the appendix may be pulled up as high
as the liver.
Perhaps my schematic representations shown here may only be of
historical value, but as Goethe said, “To see the future we
must look to the past.”
Thank you once again for remembering a pioneer who is enormously
proud of the work of many surgeons who have taken up the gauntlet
ensuring a safer, less painful, and equally effective surgery for
Email: [email protected]