Appendectomy ranks among the most common surgical procedures. Laparoscopic appendectomy has become increasingly popular among certain surgeons. Even laparoscopic appendectomy is considered the gold standard; many surgical subspecialties have adopted robotic surgery in the past 10 years. The robotic system is recognized for enhancing stability, visualization, precision, and spatial flexibility. Surgeons can operate with enhanced dexterity, reduced tremors, three-dimensional visualization, up to 10 times magnification, and control over four arms thanks to improved ergonomics that allow them to sit at a customizable console. The purpose of this study is to evaluate and compare the overall effects, such as intraoperative time, postoperative recovery, feasibility for surgeons, and cost-effectiveness, of robotic-assisted appendectomy and laparoscopic appendectomy through the available literature. It was found that both robotic and laparoscopic surgeries work well for appendectomy, but in some studies, it was found that robotic surgery comes with the perks of shorter hospital stays and quicker recovery, even though it is more expensive, and in some studies, no differences were observed in patient recovery postoperatively. Laparoscopic surgery is still a highly effective and commonly used method, with proven advantages over open appendectomy, despite taking longer for the procedure. We need more studies to fully understand the advantages and disadvantages of robotic surgery, especially when it comes to cost-effectiveness and wider health outcomes.

Accumulation of experience with minimally invasive surgery over the last three decades has rendered laparoscopic surgery the mainstay of management for surgical pathology during pregnancy. In the present meta-review, we compiled the available evidence on the safety of laparoscopic and robotic-assisted surgeries during pregnancy, based on relevant systematic reviews (SR) and meta-analyses (MA). A systematic review was performed for articles published until February 2024 in English using PubMed/MEDLINE (Medical Literature Analysis and Retrieval System Online) and Google Scholar based on predefined selection and exclusion criteria. We implemented the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and included SRs and MAs examining women of childbearing age (population) who had undergone laparoscopic surgery or robotic-assisted laparoscopic surgery during pregnancy (intervention). The presence of comparison to open surgery was desirable but not mandatory (comparator). The included studies should necessarily report on fetal loss (outcome), and optionally on other metrics of fetal, maternal, or operative performance. We considered SRs/MAs analyzing randomized trials, observational studies, case reports, and case series (study design). The methodological quality of SRs/MAs not exclusively including case reports and case series was assessed with the Assessment of Multiple Systematic Reviews (AMSTAR) 2 instrument. A total of 1229 articles were screened, of which 78 were potentially eligible. Of these, 33 articles met our inclusion criteria, 18 containing SRs only and 15 SRs with MA. The examined disciplines were laparoscopic appendectomy (10 studies, 30.3%), laparoscopic cerclage for cervical insufficiency (eight studies, 24.2%), adnexal-ovarian laparoscopic surgery (five studies, 15.2%), laparoscopic cholecystectomy and biliary tree exploration (three studies, 9.1%), laparoscopic myomectomy (two studies, 6.1%), and one study each for laparoscopic surgery regarding pancreatic indications, adrenal indications, and bariatric complications (3.0%). The odds ratio/relative risk for fetal loss rate ranged from 0-1.9, with variable statistical significance depending on the discipline. Twenty-three out of the 33 studies were submitted to quality evaluation with the AMSTAR 2 instrument, with three being of \"low quality\" (13.0%) and the remaining 20 of \"critically low quality\" (87.0%). In conclusion, the widespread acceptance of laparoscopic surgery for treating surgical pathology during pregnancy is substantiated by heterogeneous and low-quality evidence. Literature mainly revolves around laparoscopic appendectomy, whereas other disciplines that may commonly arise during pregnancy, such as cholecystectomy and the acute abdomen following bariatric surgery, are underrepresented in the literature. Factors such as anatomical alterations that may affect surgical access, surgeon\'s expertise, and the biological course of the underlying pathology should be taken into consideration when selecting the appropriate mode of operating during pregnancy.

This is a case report of an 82-year-old male who presented with intractable and diffuse abdominal pain and had a computed tomography (CT) abdomen showing a closed loop obstruction in the right hemiabdomen with anteromedial displacement of the cecum and ascending colon. Exploratory laparotomy revealed a gangrenous segment of the ileum strangulated by a transomental hernia in the right lower quadrant. The nonviable bowel was resected, and the healthy bowel segments were anastomosed. It is important to correlate the clinical signs of bowel obstruction with radiographic findings of internal hernia to expedite surgical intervention and prevent complications of bowel ischemia.

BACKGROUND: Acute appendicitis is one of the most common acute abdominal issues requiring surgery and is usually treated by appendectomy. During the process of removing the appendix, the appendiceal artery is severed. In most individuals, the appendix is supplied by only one appendiceal artery.
METHODS: A 50-year-old man underwent appendectomy. During the surgical procedure, the appendix artery and two accessory arteries of the appendix were severed, leading to massive hemorrhaging in the abdominal cavity, which ultimately resulted in the patient\'s unfortunate demise.
CONCLUSIONS: Through this case, we hope that surgeons can learn more about the anatomy of the appendiceal artery and understand the possibility of accessory arteries to the appendix. During surgery, the blood vessels supplying the appendix should be carefully explored, and the \"one-size-fits-all approach\" should be avoided. Moreover, attention should be given to complications after appendectomy, and timely symptomatic treatment should be provided. Key points 1. Rare typing: The case of death due to improper handling of the accessory appendicular artery during appendectomy in patients with three appendiceal arteries is currently unreported. 2. Detailed anatomical knowledge: Surgeons performing an appendectomy need to make a detailed exploration of the blood vessel supply of the appendix to avoid ignoring anatomically different blood vessels. 3. Avoid a one-size-fits-all approach: In the surgical process, a \"one-size-fits-all\" approach should be avoided, that is, the same surgical approach should not be used in all cases, but should be adjusted according to the anatomical characteristics of the individual. 4. Observation of postoperative bleeding: In the perioperative period, peritoneal drainage should be closely observed. If a large amount of bloody fluid is found, timely surgical treatment should be carried out. 5. Attention to complications: Surgeons should pay.

BACKGROUND: Laparoscopic appendectomy is a common procedure and introduced early in general surgical training. How internal (i.e. surgeon\'s experience) or external (i.e. disease severity) may affect procedure performance is not well-studied. The aim of this study was to evaluate factors that may have an influence on the performance scores for surgical trainees.
METHODS: A prospective, observational cohort study of laparoscopic appendectomies performed by surgical trainees (experience < 4 years) operating under supervision. Trainers evaluated trainees\' overall performance on a 6-point scale for proficiency. Perioperative data were recorded, including appendicitis severity, operating time and the overall difficulty of the procedure as assessed by the trainer. A \"Challenging\" procedure was defined as a combination of either/or \"perforation\" and \"difficult\". Trainees who had performed > 30 appendectomies were defined as \"experienced\". The trainees were asked if they had used simulation or web-based tools the week prior to surgery.
RESULTS: 142 procedure evaluation forms were included of which 19 (13%) were \"perforated\", 14 (10%) \"difficult\" and 24 (17%) \"Challenging\". Perforated appendicitis was strongly associated with procedure difficulty (OR 21.2, 95% CI 6.0-75.6). Experienced trainees performed \"proficient\" more often than non-experienced (OR 34.5, 95% CI 6.8-176.5). \"Difficult\" procedures were inversely associated with proficiency (OR 0.1, 95% CI 0.0-0.9). In \"Challenging\" procedures, identifying the appendix had lowest proficiency (OR 0.4, 95% CI 0.1-0.9). The procedures assessed as \"difficult\" had significantly longer operating time with a median (IQR) of 90 (75-100) min compared to 59 (25-120) min for the non-difficult (p < 0.001).
CONCLUSIONS: Both internal and external factors contribute to the performance score. Perforated appendicitis, technical difficult procedures and trainee experience all play a role, but a \"difficult\" procedure had most overall impact on proficiency evaluation.

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Paraduodenal hernias (PDH) pose a diagnostic challenge due to their varied presentations and rarity. We report a rare case report illustrating the clinical course, diagnostic approach, and management of PDH in a 19-year-old female patient with a history of neonatal laparotomy for intestinal atresia. The patient initially presented with chronic, diffuse abdominal pain, which had progressively worsened over 2 years. Physical examination revealed no palpable mass, with normal bowel sounds and vital signs. Imaging studies, including computed tomography of the abdomen, demonstrated protrusion of small bowel loops in the left upper abdominal quadrant consistent with a left paraduodenal hernia. Following laparoscopic exploration, a large defect was identified, and successful repair was performed, resulting in resolution of symptoms and a smooth postoperative recovery. Our case highlights the importance of maintaining a high index of suspicion for PDH in patients with chronic abdominal pain, particularly those with a history of abdominal surgeries. Prompt diagnosis and timely surgical intervention, preferably laparoscopic, can lead to favorable outcomes and improved quality of life for affected individuals.

Common complications following laparoscopic appendectomy include wound infection, bleeding, intra-abdominal abscess, small bowel obstruction, stump leakage, and stump appendicitis. Here, we presented a case reporting detailing a rare complication following laparoscopic appendectomy: the development of a metastatic neck abscess induced by Klebsiella pneumoniae(K. pneumoniae). A 49-year-old male underwent emergency laparoscopic surgery with prophylactic antibiotic administration for acute appendicitis. Subsequently, he experienced persistent neck pain and fever postoperatively, prompting further investigation. Pus and blood cultures revealed K. pneumoniae, with magnetic resonance imaging confirming the presence of a neck abscess. Antibiotic therapy was adjusted, and surgical drainage of the abscess was performed after multidisciplinary consultation. The patient was discharged without complications. While rare, metastatic abscesses following appendectomy warrant consideration, particularly in K. pneumoniae infections. Comprehensive clinical assessment, imaging, and laboratory evaluation are crucial for timely diagnosis and management of such complications.

Background: Today, laparoscopy is frequently used in abdominal emergencies such as acute appendicitis. There are several techniques used to close the appendiceal stump during laparoscopic appendectomy. We aimed to compare the use of handmade loop and Hem-o-lok used to close the appendiceal stump in public hospitals where resources are limited, in terms of surgical outcomes and cost. Methods: Between January 2020 and December 2022, patients for whom handmade loops and Hem-o-loks were used to close the appendiceal stump during laparoscopic appendectomy in our clinic were included in the study. There were a total of 638 patients (mean age: 33 ± 13.5 years, 325 females and 313 males) in the patient cohort. Demographic and clinical data, duration of surgery, complications, hospital stay, pathology reports, mortality, and cost of supplies were compared between the two groups. Results: There were 308 patients in the handmade loop group (160 females, 148 males, mean age: 33.7 years, range: 18-85 years) and 330 patients in the Hem-o-lok group (166 females, 164 males, mean age: 32.5 years, range: 18-89 years). There was no significant difference between the two groups for American Society of Anesthesiologists score, duration of symptom, hospital stay, intensive care unit stay, preoperative laboratory values, histopathological results, mortality, and morbidity (P > .05). The mean operation time was 48.76 ± 16.16 minutes in the handmade loop group and 40.53 ± 11.63 minutes in the Hem-o-lok group (p = 0.001). In terms of cost, the cost per case of Hem-o-lok group was about 25.8 times as much as the group that used sutures ($31 versus $1.2). Conclusions: Both methods can be used safely in laparoscopic appendectomy. The use of Hem-o-lok has no advantage other than shortening the operation time. However, it is costlier. Especially in peripheral hospitals where resources are limited, closing the appendiceal stump using a handmade loop is an easy, safe, and cost-effective method.

BACKGROUND: Acute lower gastrointestinal bleeding (LGIB) is a common occurrence in clinical practice. However, appendiceal bleeding is an extremely rare condition that can easily be overlooked and misdiagnosed. The preoperative detection of appendiceal bleeding often poses challenges due to the lack of related guidelines and consensus, resulting in controversial treatment approaches.
METHODS: We presented a case of a 33-year-old female who complained of hematochezia that had lasted for 1 d. Colonoscopy revealed continuous bleeding in the appendiceal orifice. A laparoscopic appendectomy was performed immediately, and a pulsating blood vessel was observed in the mesangium of the appendix, accordingly, active bleeding into the appendicular lumen was considered. Pathological examination revealed numerous hyperplastic vessels in the appendiceal mucosa and dilated capillary vessels.
CONCLUSIONS: The preoperative detection of appendiceal bleeding is often challenging, colonoscopy is extremely important, bowel preparation is not routinely recommended for patients with acute LGIB or only low-dose bowel preparation is recommended. Laparoscopic appendectomy is the most appropriate treatment for appendiceal bleeding.