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"LETTER FROM A PIONER"

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 to publish.

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 – F )
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 all patients.