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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
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.