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Erschienen in: Der Chirurg 3/2019

12.11.2018 | Laparoskopie | Leitthema

Appendektomie: offen vs. laparoskopisch vs. Single-Port

Evidenz der operativen Verfahrenswahl

verfasst von: Dr. Sven Förster, Jörn Bernhardt, Kaja Ludwig

Erschienen in: Die Chirurgie | Ausgabe 3/2019

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Zusammenfassung

Die Therapie der Wahl bei der akuten Appendizitis ist unverändert die operative Entfernung der entzündeten Appendix vermiformis. Bezüglich des optimalen Zuganges, konventionell offen oder minimal-invasiv, besteht noch teilweise Uneinigkeit. Anhand der besten verfügbaren Evidenz wird versucht, die Frage nach der derzeit optimalen Verfahrenswahl zu beantworten. Für die laparoskopische Appendektomie bestehen evidenzbasierte Vorteile in Bezug auf das Zugangstrauma, den postoperativen Schmerzmittelbedarf, die Wundinfektionsrate sowie die Rekonvaleszenz. Für die alternativen minimal-invasiven Verfahren Single-Port-Appendektomie, minilaparoskopische Appendektomie oder NOTES-Appendektomie fehlt insgesamt noch die wissenschaftliche Evidenz, um den breiten klinischen Einsatz dieser Verfahren zu befürworten. Es wird empfohlen, dass überall dort, wo es die Infrastruktur erlaubt, die laparoskopische Appendektomie die Therapie der Wahl darstellen sollte.
Literatur
1.
Zurück zum Zitat Addiss DG, Shaffer N, Fowler BS, Tauxe RV (1990) The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol 132(5):910–925 Addiss DG, Shaffer N, Fowler BS, Tauxe RV (1990) The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol 132(5):910–925
2.
Zurück zum Zitat Amyand C (1735) Of an inguinal rupture, with a pin in the appendix caeci, incrusted with stone; and some observations on wounds in the guts. Philos Trans R Soc Lond 39:329–336 Amyand C (1735) Of an inguinal rupture, with a pin in the appendix caeci, incrusted with stone; and some observations on wounds in the guts. Philos Trans R Soc Lond 39:329–336
3.
Zurück zum Zitat McBurney C (1894) The incision made in the abdominal wall in cases of appendicitis, with a description of a new method of operating. Ann Surg 20(1):38–43 McBurney C (1894) The incision made in the abdominal wall in cases of appendicitis, with a description of a new method of operating. Ann Surg 20(1):38–43
4.
Zurück zum Zitat Semm K (1983) Endoscopic appendectomy. Endoscopy 15(2):59–64 Semm K (1983) Endoscopic appendectomy. Endoscopy 15(2):59–64
5.
Zurück zum Zitat Jaschinski T, Mosch C, Eikermann M, Neugebauer EA (2015) Laparoscopic versus open appendectomy in patients with suspected appendicitis: a systematic review of meta-analyses of randomised controlled trials. BMC Gastroenterol 15:48 Jaschinski T, Mosch C, Eikermann M, Neugebauer EA (2015) Laparoscopic versus open appendectomy in patients with suspected appendicitis: a systematic review of meta-analyses of randomised controlled trials. BMC Gastroenterol 15:48
6.
Zurück zum Zitat Golub R, Siddiqui F, Pohl D (1998) Laparoscopic versus open appendectomy: a metaanalysis. J Am Coll Surg 186(5):545–553 Golub R, Siddiqui F, Pohl D (1998) Laparoscopic versus open appendectomy: a metaanalysis. J Am Coll Surg 186(5):545–553
7.
Zurück zum Zitat Meynaud-Kraemer L, Colin C, Vergnon P, Barth X (1999) Wound infection in open versus laparoscopic appendectomy. Int J Technol Assess Health Care 15(2):380–391 Meynaud-Kraemer L, Colin C, Vergnon P, Barth X (1999) Wound infection in open versus laparoscopic appendectomy. Int J Technol Assess Health Care 15(2):380–391
8.
Zurück zum Zitat Temple LK, Litwin DE, McLeod RS (1999) A meta-analysis of laparoscopic versus open appendectomy in patients suspected of having acute appendicitis. Can J Surg 42(5):377–383 Temple LK, Litwin DE, McLeod RS (1999) A meta-analysis of laparoscopic versus open appendectomy in patients suspected of having acute appendicitis. Can J Surg 42(5):377–383
9.
Zurück zum Zitat Bennett J, Boddy A, Rhodes M (2007) Choice of approach for appendicectomy: a meta-analysis of open versus laparoscopic appendicectomy. Surg Laparosc Endosc Percutan Tech 17(4):245–255 Bennett J, Boddy A, Rhodes M (2007) Choice of approach for appendicectomy: a meta-analysis of open versus laparoscopic appendicectomy. Surg Laparosc Endosc Percutan Tech 17(4):245–255
10.
Zurück zum Zitat Li X, Zhang J, Sang L, Zhang W, Chu Z, Li X, Liu Y (2010) Laparoscopic versus conventional appendectomy—a meta-analysis of randomized controlled trials. BMC Gastroenterol 10:129 Li X, Zhang J, Sang L, Zhang W, Chu Z, Li X, Liu Y (2010) Laparoscopic versus conventional appendectomy—a meta-analysis of randomized controlled trials. BMC Gastroenterol 10:129
11.
Zurück zum Zitat Liu Z, Zhang P, Ma Y, Chen H, Zhou Y, Zhang M, Chu Z, Qin H (2010) Laparoscopy or not: a meta-analysis of the surgical effects of laparoscopic versus open appendicectomy. Surg Laparosc Endosc Percutan Tech 20(6):362–370 Liu Z, Zhang P, Ma Y, Chen H, Zhou Y, Zhang M, Chu Z, Qin H (2010) Laparoscopy or not: a meta-analysis of the surgical effects of laparoscopic versus open appendicectomy. Surg Laparosc Endosc Percutan Tech 20(6):362–370
13.
Zurück zum Zitat Wei B, Qi CL, Chen TF, Zheng ZH, Huang JL, Hu BG, Wei HB (2011) Laparoscopic versus open appendectomy for acute appendicitis: a metaanalysis. Surg Endosc 25(4):1199–1208 Wei B, Qi CL, Chen TF, Zheng ZH, Huang JL, Hu BG, Wei HB (2011) Laparoscopic versus open appendectomy for acute appendicitis: a metaanalysis. Surg Endosc 25(4):1199–1208
14.
Zurück zum Zitat Ohtani H, Tamamori Y, Arimoto Y, Nishiguchi Y, Maeda K, Hirakawa K (2012) Meta-analysis of the results of randomized controlled trials that compared laparoscopic and open surgery for acute appendicitis. J Gastrointest Surg 16(10):1929–1939 Ohtani H, Tamamori Y, Arimoto Y, Nishiguchi Y, Maeda K, Hirakawa K (2012) Meta-analysis of the results of randomized controlled trials that compared laparoscopic and open surgery for acute appendicitis. J Gastrointest Surg 16(10):1929–1939
15.
Zurück zum Zitat Markides G, Subar D, Riyad K (2010) Laparoscopic versus open appendectomy in adults with complicated appendicitis: systematic review and meta-analysis. World J Surg 34(9):2026–2040 Markides G, Subar D, Riyad K (2010) Laparoscopic versus open appendectomy in adults with complicated appendicitis: systematic review and meta-analysis. World J Surg 34(9):2026–2040
16.
Zurück zum Zitat Swank HA, Eshuis EJ, van Berge Henegouwen MI, Bemelman WA (2011) Short- and long-term results of open versus laparoscopic appendectomy. World J Surg 35(6):1221–1226 Swank HA, Eshuis EJ, van Berge Henegouwen MI, Bemelman WA (2011) Short- and long-term results of open versus laparoscopic appendectomy. World J Surg 35(6):1221–1226
17.
Zurück zum Zitat Schmedt CG, Leibl BJ, Bittner R (2002) Zugangsbedingte Komplikationen in der laparoskopischen Chirurgie. Chirurg 73:863–879 Schmedt CG, Leibl BJ, Bittner R (2002) Zugangsbedingte Komplikationen in der laparoskopischen Chirurgie. Chirurg 73:863–879
18.
Zurück zum Zitat Ukai T, Shikata S, Takeda H, Dawes L, Noguchi Y, Nakayama T, Takemura YC (2016) Evidence of surgical outcomes fluctuates over time: results from a cumulative meta-analysis of laparoscopic versus open appendectomy for acute appendicitis. BMC Gastroenterol 16:37 Ukai T, Shikata S, Takeda H, Dawes L, Noguchi Y, Nakayama T, Takemura YC (2016) Evidence of surgical outcomes fluctuates over time: results from a cumulative meta-analysis of laparoscopic versus open appendectomy for acute appendicitis. BMC Gastroenterol 16:37
19.
Zurück zum Zitat Southgate E, Vousden N, Karthikesalingam A, Markar SR, Black S, Zaidi A (2012) Laparoscopic versus open appendectomy in older patients. Arch Surg 147(6):557–562 Southgate E, Vousden N, Karthikesalingam A, Markar SR, Black S, Zaidi A (2012) Laparoscopic versus open appendectomy in older patients. Arch Surg 147(6):557–562
20.
Zurück zum Zitat Ciarrocchi A, Amicucci G (2014) Laparoscopic versus open appendectomy in obese patients: a meta-analysis of prospective and retrospective studies. J Minim Access Surg 10(1):4–9 Ciarrocchi A, Amicucci G (2014) Laparoscopic versus open appendectomy in obese patients: a meta-analysis of prospective and retrospective studies. J Minim Access Surg 10(1):4–9
21.
Zurück zum Zitat Dasari BV, Baker J, Markar S, Gardiner K (2015) Laparoscopic appendicectomy in obese is associated with improvements in clinical outcome: systematic review. Int J Surg 13:250–256 Dasari BV, Baker J, Markar S, Gardiner K (2015) Laparoscopic appendicectomy in obese is associated with improvements in clinical outcome: systematic review. Int J Surg 13:250–256
22.
Zurück zum Zitat Corneille MG, Steigelman MB, Myers JG, Jundt J, Dent DL, Lopez PP, Cohn SM, Stewart RM (2007) Laparoscopic appendectomy is superior to open appendectomy in obese patients. Am J Surg 194:877–880 Corneille MG, Steigelman MB, Myers JG, Jundt J, Dent DL, Lopez PP, Cohn SM, Stewart RM (2007) Laparoscopic appendectomy is superior to open appendectomy in obese patients. Am J Surg 194:877–880
23.
Zurück zum Zitat Varela JE, Hinojosa MW, Nguyen NT (2008) Laparoscopy should be the approach of choice for acute appendicitis in the morbidly obese. Am J Surg 196:218–222 Varela JE, Hinojosa MW, Nguyen NT (2008) Laparoscopy should be the approach of choice for acute appendicitis in the morbidly obese. Am J Surg 196:218–222
24.
Zurück zum Zitat Clarke T, Katkhouda N, Mason RJ, Cheng BC, Olasky J, Sohn HJ, Moazzez A, Algra J, Chaghouri E, Berne TV (2011) Laparoscopic versus open appendectomy for the obese patient: a subset analysis from a prospective, randomized, double-blind study. Surg Endosc 25:1276–1280 Clarke T, Katkhouda N, Mason RJ, Cheng BC, Olasky J, Sohn HJ, Moazzez A, Algra J, Chaghouri E, Berne TV (2011) Laparoscopic versus open appendectomy for the obese patient: a subset analysis from a prospective, randomized, double-blind study. Surg Endosc 25:1276–1280
25.
Zurück zum Zitat Masoomi H, Nguyen NT, Dolich MO, Wikholm L, Naderi N, Mills S, Stamos MJ (2011) Comparison of laparoscopic versus open appendectomy for acute nonperforated and perforated appendicitis in the obese population. Am J Surg 202:733–773 Masoomi H, Nguyen NT, Dolich MO, Wikholm L, Naderi N, Mills S, Stamos MJ (2011) Comparison of laparoscopic versus open appendectomy for acute nonperforated and perforated appendicitis in the obese population. Am J Surg 202:733–773
26.
Zurück zum Zitat Mason RJ, Moazzez A, Moroney JR, Katkhouda N (2012) Laparoscopic vs open appendectomy in obese patients: outcomes using the American College of Surgeons National Surgical Quality Improvement Program database. J Am Coll Surg 215:88–99 Mason RJ, Moazzez A, Moroney JR, Katkhouda N (2012) Laparoscopic vs open appendectomy in obese patients: outcomes using the American College of Surgeons National Surgical Quality Improvement Program database. J Am Coll Surg 215:88–99
27.
Zurück zum Zitat Tan-Tam C, Yorke E, Wasdell M, Barcan C, Konkin D, Blair P (2012) The benefits of laparoscopic appendectomies in obese patients. Am J Surg 203:609–612 Tan-Tam C, Yorke E, Wasdell M, Barcan C, Konkin D, Blair P (2012) The benefits of laparoscopic appendectomies in obese patients. Am J Surg 203:609–612
28.
Zurück zum Zitat Förster S, Reimer T, Rimbach S, Louwen F, Volk T, Bürkle H, Benecke C, Carus T, Türler A, Wullstein C, Ludwig K (2016) CAMIC-Empfehlungen zur chirurgischen Laparoskopie aus nicht geburtshilflicher Indikation während der Schwangerschaft. Zentralbl Chir 141(5):538–544 Förster S, Reimer T, Rimbach S, Louwen F, Volk T, Bürkle H, Benecke C, Carus T, Türler A, Wullstein C, Ludwig K (2016) CAMIC-Empfehlungen zur chirurgischen Laparoskopie aus nicht geburtshilflicher Indikation während der Schwangerschaft. Zentralbl Chir 141(5):538–544
29.
Zurück zum Zitat McGory ML, Zingmond DS, Tillou A, Hiatt JR, Ko CY, Cryer HM (2007) Negative appendectomy in pregnant women is associated with a substantial risk of fetal loss. J Am Coll Surg 205(4):534–540 McGory ML, Zingmond DS, Tillou A, Hiatt JR, Ko CY, Cryer HM (2007) Negative appendectomy in pregnant women is associated with a substantial risk of fetal loss. J Am Coll Surg 205(4):534–540
30.
Zurück zum Zitat Markar SR, Blackburn S, Cobb R, Karthikesalinqam A, Evans J, Kinross J, Faiz O (2012) Laparoscopic versus open appendectomy for complicated and uncomplicated appendicitis in children. J Gastrointest Surg 16(10):1993–2004 Markar SR, Blackburn S, Cobb R, Karthikesalinqam A, Evans J, Kinross J, Faiz O (2012) Laparoscopic versus open appendectomy for complicated and uncomplicated appendicitis in children. J Gastrointest Surg 16(10):1993–2004
31.
Zurück zum Zitat Di Saverio S, Birindelli A, Kelly MD, Catena F, Weber DG, Sartelli M, Sugrue M, De Moya M, Gomes CA, Bhangu A, Agresta F, Moore EE, Soreide K, Griffiths E, De Castro S, Kashuk J, Kluger Y, Leppaniemi A, Ansaloni L, Andersson M, Coccolini F, Coimbra R, Gurusamy KS, Campanile FC, Biffl W, Chiara O, Moore F, Peitzman AB, Fraga GP, Costa D, Maier RV, Rizoli S, Balogh ZJ, Bendinelli C, Cirocchi R, Tonini V, Piccinini A, Tugnoli G, Jovine E, Persiani R, Biondi A, Scalea T, Stahel P, Ivatury R, Velmahos G, Andersson R (2016) WSES Jerusalem guidelines for diagnosis and treatment of acute appendicitis. World J Emerg Surg 11:34 Di Saverio S, Birindelli A, Kelly MD, Catena F, Weber DG, Sartelli M, Sugrue M, De Moya M, Gomes CA, Bhangu A, Agresta F, Moore EE, Soreide K, Griffiths E, De Castro S, Kashuk J, Kluger Y, Leppaniemi A, Ansaloni L, Andersson M, Coccolini F, Coimbra R, Gurusamy KS, Campanile FC, Biffl W, Chiara O, Moore F, Peitzman AB, Fraga GP, Costa D, Maier RV, Rizoli S, Balogh ZJ, Bendinelli C, Cirocchi R, Tonini V, Piccinini A, Tugnoli G, Jovine E, Persiani R, Biondi A, Scalea T, Stahel P, Ivatury R, Velmahos G, Andersson R (2016) WSES Jerusalem guidelines for diagnosis and treatment of acute appendicitis. World J Emerg Surg 11:34
32.
Zurück zum Zitat Pelosi MA, Pelosi MA (1992) Laparoscopic appendectomy using a single umbilical puncture (minilaparoscopy). J Reprod Med 37:588–594 Pelosi MA, Pelosi MA (1992) Laparoscopic appendectomy using a single umbilical puncture (minilaparoscopy). J Reprod Med 37:588–594
33.
Zurück zum Zitat Deng L, Xiong J, Xia Q (2017) Single-incision versus conventional three-incision laparoscopic appendectomy: a meta-analysis of randomized controlled trials. J Evid Based Med 10(3):196–206 Deng L, Xiong J, Xia Q (2017) Single-incision versus conventional three-incision laparoscopic appendectomy: a meta-analysis of randomized controlled trials. J Evid Based Med 10(3):196–206
34.
Zurück zum Zitat Park JH, Hyun KH, Park CH, Choi SY, Choi WH, Kim DJ, Lee S, Kim JS (2010) Laparoscopic vs transumbilical single-port laparoscopic appendectomy; results of prospective randomized trial. J Korean Surg Soc 78(4):213–218 Park JH, Hyun KH, Park CH, Choi SY, Choi WH, Kim DJ, Lee S, Kim JS (2010) Laparoscopic vs transumbilical single-port laparoscopic appendectomy; results of prospective randomized trial. J Korean Surg Soc 78(4):213–218
35.
Zurück zum Zitat St Peter SD, Adibe OO, Juang D, Sharp SW, Garey CL, Laituri CA, Murphy JP, Andrews WS, Sharp RJ, Snyder CL, Holcomb GW 3rd, Ostlie DJ (2011) Single incision versus standard 3‑port laparoscopic appendectomy: a prospective randomized trial. Ann Surg 254(4):586–590 St Peter SD, Adibe OO, Juang D, Sharp SW, Garey CL, Laituri CA, Murphy JP, Andrews WS, Sharp RJ, Snyder CL, Holcomb GW 3rd, Ostlie DJ (2011) Single incision versus standard 3‑port laparoscopic appendectomy: a prospective randomized trial. Ann Surg 254(4):586–590
36.
Zurück zum Zitat Teoh AY, Chiu PW, Wong TC, Poon MC, Wong SK, Leong HT, Lai PB, Ng EK (2012) A double-blinded randomized controlled trial of laparoendoscopic single-site access versus conventional 3‑port appendectomy. Ann Surg 256(6):909–914 Teoh AY, Chiu PW, Wong TC, Poon MC, Wong SK, Leong HT, Lai PB, Ng EK (2012) A double-blinded randomized controlled trial of laparoendoscopic single-site access versus conventional 3‑port appendectomy. Ann Surg 256(6):909–914
37.
Zurück zum Zitat Perez EA, Piper H, Burkhalter LS, Fischer AC (2013) Single-incision laparoscopic surgery in children: a randomized control trial of acute appendicitis. Surg Endosc 27:1367–1371 Perez EA, Piper H, Burkhalter LS, Fischer AC (2013) Single-incision laparoscopic surgery in children: a randomized control trial of acute appendicitis. Surg Endosc 27:1367–1371
38.
Zurück zum Zitat Pan Z, Jiang XH, Zhou JH, Ji ZL (2013) Transumbilical single-incision laparoscopic appendectomy using conventional instruments: the single working channel technique. Surg Laparosc Endosc Percutan Tech 23(2):208–211 Pan Z, Jiang XH, Zhou JH, Ji ZL (2013) Transumbilical single-incision laparoscopic appendectomy using conventional instruments: the single working channel technique. Surg Laparosc Endosc Percutan Tech 23(2):208–211
39.
Zurück zum Zitat Kye BH, Lee J, Kim W, Kim D, Lee D (2013) Comparative study between single-incision and three-port laparoscopic appendectomy: a prospective randomized trial. J Laparoendosc Adv Surg Tech A 23(5):431–436 Kye BH, Lee J, Kim W, Kim D, Lee D (2013) Comparative study between single-incision and three-port laparoscopic appendectomy: a prospective randomized trial. J Laparoendosc Adv Surg Tech A 23(5):431–436
40.
Zurück zum Zitat Lee WS, Choi ST, Lee JN, Kim KK, Park YH, Lee WK, Baek JH, Lee TH (2013) Single-port laparoscopic appendectomy versus conventional laparoscopic appendectomy: a prospective randomized controlled study. Ann Surg 257(2):214–218 Lee WS, Choi ST, Lee JN, Kim KK, Park YH, Lee WK, Baek JH, Lee TH (2013) Single-port laparoscopic appendectomy versus conventional laparoscopic appendectomy: a prospective randomized controlled study. Ann Surg 257(2):214–218
41.
Zurück zum Zitat Frutos MD, Abrisqueta J, Lujan J, Abellan I, Parrilla P (2013) Randomized prospective study to compare laparoscopic appendectomy versus umbilical single-incision appendectomy. Ann Surg 257(3):413–418 Frutos MD, Abrisqueta J, Lujan J, Abellan I, Parrilla P (2013) Randomized prospective study to compare laparoscopic appendectomy versus umbilical single-incision appendectomy. Ann Surg 257(3):413–418
42.
Zurück zum Zitat Sozutek A, Colak T, Dirlik M, Ocal K, Turkmenoglu O, Dag A (2013) A prospective randomized comparison of single-port laparoscopic procedure with open and standard 3‑port laparoscopic procedures in the treatment of acute appendicitis. Surg Laparosc Endosc Percutan Tech 23(1):74–78 Sozutek A, Colak T, Dirlik M, Ocal K, Turkmenoglu O, Dag A (2013) A prospective randomized comparison of single-port laparoscopic procedure with open and standard 3‑port laparoscopic procedures in the treatment of acute appendicitis. Surg Laparosc Endosc Percutan Tech 23(1):74–78
43.
Zurück zum Zitat Carter JT, Kaplan JA, Nguyen JN, Lin MY, Rogers SJ, Harris HW (2014) A prospective, randomized controlled trial of single-incision laparoscopic vs conventional 3‑port laparoscopic appendectomy for treatment of acute appendicitis. J Am Coll Surg 218(5):950–959 Carter JT, Kaplan JA, Nguyen JN, Lin MY, Rogers SJ, Harris HW (2014) A prospective, randomized controlled trial of single-incision laparoscopic vs conventional 3‑port laparoscopic appendectomy for treatment of acute appendicitis. J Am Coll Surg 218(5):950–959
44.
Zurück zum Zitat Villalobos MR, Escoll RJ, Herrerías GF, Mias Carballal MC, Escartin AA, Olsina Kissler JJ (2014) Prospective, randomized comparative study between single-port laparoscopic appendectomy and conventional laparoscopic appendectomy. Cir Esp 92(7):472–477 Villalobos MR, Escoll RJ, Herrerías GF, Mias Carballal MC, Escartin AA, Olsina Kissler JJ (2014) Prospective, randomized comparative study between single-port laparoscopic appendectomy and conventional laparoscopic appendectomy. Cir Esp 92(7):472–477
45.
Zurück zum Zitat Vettoretto N, Cirocchi R, Randolph J, Morino M (2015) Acute appendicitis can be treated with single incision laparoscopy: a systematic review of randomized controlled trials. Colorectal Dis 17(4):281–289 Vettoretto N, Cirocchi R, Randolph J, Morino M (2015) Acute appendicitis can be treated with single incision laparoscopy: a systematic review of randomized controlled trials. Colorectal Dis 17(4):281–289
46.
Zurück zum Zitat Haueter R, Schütz T, Raptis DA, Clavien PA, Zuber M (2017) Meta-analysis of single-port versus conventional laparoscopic cholecystectomy comparing body image and cosmesis. Br J Surg 104(9):1141–1159 Haueter R, Schütz T, Raptis DA, Clavien PA, Zuber M (2017) Meta-analysis of single-port versus conventional laparoscopic cholecystectomy comparing body image and cosmesis. Br J Surg 104(9):1141–1159
47.
Zurück zum Zitat Gagner M, Garcia-Ruiz A (1998) Technical aspects of minimally invasive abdominal surgery performed with needlescopic instruments. Surg Laparosc Endosc 8(3):171–179 Gagner M, Garcia-Ruiz A (1998) Technical aspects of minimally invasive abdominal surgery performed with needlescopic instruments. Surg Laparosc Endosc 8(3):171–179
48.
Zurück zum Zitat Rattner D, Kalloo A, ASGE/SAGES Working Group (2006) ASGE/SAGES working group on natural orifice translumenal endoscopic surgery. October 2005. Surg Endosc 20(2):329–333 Rattner D, Kalloo A, ASGE/SAGES Working Group (2006) ASGE/SAGES working group on natural orifice translumenal endoscopic surgery. October 2005. Surg Endosc 20(2):329–333
49.
Zurück zum Zitat Tsin DA, Colombero LT, Mahmood D, Padouvas J, Manolas P (2001) Operative culdolaparoscopy: a new approach combining operative culdoscopy and minilaparoscopy. J Am Assoc Gynecol Laparosc 8(3):438–441 Tsin DA, Colombero LT, Mahmood D, Padouvas J, Manolas P (2001) Operative culdolaparoscopy: a new approach combining operative culdoscopy and minilaparoscopy. J Am Assoc Gynecol Laparosc 8(3):438–441
51.
Zurück zum Zitat Bernhardt J, Steffen H, Schneider-Koriath S, Ludwig K (2015) Clinical NOTES appendectomy study: comparison of transvaginal NOTES appendectomy in hybrid technique with laparoscopic appendectomy. Int J Colorectal Dis 30(2):259–267 Bernhardt J, Steffen H, Schneider-Koriath S, Ludwig K (2015) Clinical NOTES appendectomy study: comparison of transvaginal NOTES appendectomy in hybrid technique with laparoscopic appendectomy. Int J Colorectal Dis 30(2):259–267
52.
Zurück zum Zitat Bulian DR, Kaehler G, Magdeburg R, Butters M, Burghardt J, Albrecht R, Bernhardt J, Heiss MM, Buhr HJ, Lehmann KS (2017) Analysis of the first 217 appendectomies of the German NOTES Registry. Ann Surg 265:534–538 Bulian DR, Kaehler G, Magdeburg R, Butters M, Burghardt J, Albrecht R, Bernhardt J, Heiss MM, Buhr HJ, Lehmann KS (2017) Analysis of the first 217 appendectomies of the German NOTES Registry. Ann Surg 265:534–538
53.
Zurück zum Zitat Bernhardt J, Gerber B, Schober HC, Kähler G, Ludwig K (2008) NOTES—case report of a unidirectional flexible appendectomy. Int J Colorectal Dis 23(5):547–550 Bernhardt J, Gerber B, Schober HC, Kähler G, Ludwig K (2008) NOTES—case report of a unidirectional flexible appendectomy. Int J Colorectal Dis 23(5):547–550
Metadaten
Titel
Appendektomie: offen vs. laparoskopisch vs. Single-Port
Evidenz der operativen Verfahrenswahl
verfasst von
Dr. Sven Förster
Jörn Bernhardt
Kaja Ludwig
Publikationsdatum
12.11.2018
Verlag
Springer Medizin
Erschienen in
Die Chirurgie / Ausgabe 3/2019
Print ISSN: 2731-6971
Elektronische ISSN: 2731-698X
DOI
https://doi.org/10.1007/s00104-018-0758-3

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