Advantages of the laparoscopic surgery in children - Forum

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John Dissector

Re: Advantages of the laparoscopic surgery in children - Ärzteforum

Post#21 »

I could rephrase your question earlier this week (would you want your child to have a lap appy?) to would you yourself want an incidental appy, in my case, the answer is yes, I would and yes, I did. However, as Michael told us last time we belabored appys, the topic is boring. Maybe you have some more interesting cases or questions to share with us? Surgery is slow out here on the northern Plains where the farmers are too busy in the fields to have surgery, so I don't have any interesting or puzzling cases to discuss. Surely, surgery in Brooklyn is more interesting.


Surrgeon

Re: Advantages of the laparoscopic surgery in children - Ärzteforum

Post#22 »

Most anesthesiologists that I know hate long cases. They would much rather have a 12 minute open appy than a 1 hour lap appy. The reason is that they make their money on the preop stuff, and the startup units. The time units are the hardest to earn. You schedule 12 PE tubes in a morning, and I'll show you a happy anesthesiologist.

I believe your premise that the cost to the patient's insurance company, medicare or medicaid is greater. However, I also believe that the lap appy is superior to the open appy, and that is is worth the cost increase. Our hospital is happy to provide me with the cost markup data. In fact its right on the OR billing sheets that the circulator is filling out while my irrigator is running out of fluid. At what point do we determine whether or not we're wasting money? How far do we go? Do we re-use scalpels? Why not rip up bed sheets for bandages? Swaged-on needles are more expensive than threaded one, you know. Is the sound system and CDs in your OR REALLY necessary?

It's priorities. On one hand I don't want to waste money, on the other hand, I want to do the best operation possible. I draw the line at a different place than you do. I cannot see myself denying my patient what I believe to be a better operation simply because it's more expensive. Very slippery slope when cost becomes a major factor in our clinical decision-making process.

bonjorno

Re: Advantages of the laparoscopic surgery in children - Ärzteforum

Post#23 »

What a joke-all this discussion over lap appes! Was anything accomplished except taking up space in my in box? surgeon wants some interesting cases. I ask for some advice on a minute thyroid Ca with mets, and I get one response, for which I am grateful. Obviously, appendectomies are much more fascinating. Chest thumping nonsense! I now clearly understand a "tempest in a teapot."

canadian

Re: Advantages of the laparoscopic surgery in children - Ärzteforum

Post#24 »

The surgeons and anesthesiologists bought the cd players, not the hospitals ;). And no, they aren't necessary, but they don't change the cost of the proceedure either.

It's just a matter of where one wants to draw the line. I`ve done lap appys, and i just didn't really see any diff between the two. Costs are not the MAJOR factor here for me, but it is a factor. I see the two proceedures outcomes to be equal. I don't see a clear advantage of one over the other, and when the new proceedure costs probably 2.5k$ more i chose the less expensive way. Doing 100 appys a yr translates to an increase of 1/4 of a million $ in costs. If i could see a CLEAR advantage doing lap appys I would change. I do see an advantage with lap chole's.

Scalpel

Re: Advantages of the laparoscopic surgery in children - Ärzteforum

Post#25 »

Appendectomies aren't more fascinating, but they are a much larger part of my day to day practice than thyroid cancers. I do 50-100 appys a yr and maybe see 1 thyroid cancer/yr-2yr. And i feel very strongly that the costs that we generate as surgeons, although not that interesting, are VERY important for us to look at for our survival.

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StSt

Re: Advantages of the laparoscopic surgery in children - Ärzteforum

Post#26 »

I also do a large number of appendectomies each year, certainly more than the number of thyroidectomies for Ca. While appendicitis, or at least its diagnosis, can be challenging, the operation itself, whether by laparotomy or laparoscopy, is usually more straightforward. I did three appendectomies on Thurs. All were acute. Is it important how fast the operations were performed, or how long the incisions were? I am sure that there are some aphorisms to cover such assertions. I apologize for my "flaming".

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A Doctor

Re: Advantages of the laparoscopic surgery in children - Ärzteforum

Post#27 »

I do agree that the benefits of lap appy are less clear (less easily defended) than in other laparoscopic endeavors. I assume that is why this topic keeps coming up and is more controversial than, say, lap chole.

The best surgeon

Re: Advantages of the laparoscopic surgery in children - Ärzteforum

Post#28 »

Would you really operate on your daughter? My 12 year old was recently admitted for observation with suspected appendicitis. She was fine despite my wife (also a doctor) and I probably being a little over anxious. With your own children it is impossible to be completely objective. I would argue that it is inappropriate to operate on one's close family. How one would deal with the results of the serious complications that Sod's Law would would produce does not bear thinking about.

Poland

Re: Advantages of the laparoscopic surgery in children - Ärzteforum

Post#29 »

I agree that lap appes cannot be universally applied, in a way that lap choles are now used. A laparoscopic appendectomy does have its usefulness as well defined in the discussions. It belongs in the general surgeon's arsenal, along side the open technique.

The best surgeon

Re: Advantages of the laparoscopic surgery in children - Ärzteforum

Post#30 »

Now, if you do an exploratory laparotomy, and find mesenteric lymphadenitis, or salpingitis, the appendectomy is really incedental, isn't it? After all it as nothing to do with treatment of the condition from which the patient is sufferring. When you do an open appendectomy, you are practically forced to take the appendix out, even if the diagnosis is not acute appendicitis, but when you do an exploratory laparoscopy, you don't have to, since there is no incision at McBurney's area. I agree that for those who do incidental appendectomies, laparoscopic appendectomy should be reserved for obese patients.

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