Tabutsadze T, Kipshidze N, 2009 Mar;(168):7-10, New trend in endoscopic surgery:

transvaginal appendectomy NOTES (Natural Orifice Transluminal Endoscopic

Surgery).

http://www.ncbi.nlm.nih.gov/pubmed/19359710

Academician N. Kipshidze Central University Hospital, Tbilisi, Georgia.

Abstract

Natural Orifice Transluminal Endoscopic Surgery is a new method of mini invasive surgery,
which involves passing surgical instruments, and a tiny camera, through a natural orifice, such as
the mouth, vagina, urethra or rectum, what provides the access to the desired organ. The
procedure is approved due to its benefits - less pain, quicker recoveries, fewer complications and
no scar - as it lets us avoid major incisions through the skin, muscle and nerves of the abdomen.
Besides that the transluminal access is considered to be the most safe and feasible for clinical
application. Here are discussed the two operations of Transvaginal Appendectomy performed in
Caucasus - Academician N. Kipshidze University Hospital in Tbilisi. The first patient - a 28-year
woman, weight - 72 kg, height - 180 cm, married, has one child - was submitted to the hospital
with anamnesis of 48 hours acute appendicitis, typical clinical semiotics and laboratory records.
In the second case the patient was a 22-year old woman, height - 170 cm, weight - 68 kg, married,
with 2 children. She was hospitalized with 24 hours acute appendicitis anamnesis and typical
clinical semiotics and laboratory records. Both operations were performed under general
anesthesia, using Karl Storz GmbH & Co. equipment. The duration of the first procedure was 76
minutes and the second operation lasted for 88 minutes. The operations were made without any
technical difficulties or complications. None of the patients had the need of non-narcotic
analgesia during the post-operational period. No gynecological or surgical problems or any
complications were detected during the observation period. The patients had superior
postoperative evolution, so the stationary stay made up 36 hours after the first operation and 30
hours after the second. Essentially NOTES is a new trend in endoscopic surgery - the non-scar
surgery with major advantages compared to the conventional - the NOTES takes endoscopic
surgery one step further in terms of reducing pain and avoiding long hospitalization and is much
more effective. The doctors hope to have more developed and flexible endoscopic surgical tools
as they are planning to perform more complicated procedures in the future. Taking in
consideration the appropriate experience of the operator the procedure is safe, more physiological
and precise. Natural-orifice surgery becomes more familiar and as more procedures are
successfully performed, the acceptance of it will grow. We consider NOTES is a challenge in
surgery and in the nearest future in case of suitable technical support it will replace not only
conventional medicine but laparoscopic too.
Diane M. Birnbaumer, MD, FACEP,

Published in Journal Watch Emergency Medicine March 26, 2010,

A New Diagnostic Test for Acute Appendicitis

http://emergency-medicine.jwatch.org/cgi/content/full/2010/326/1

Preliminary data look promising.

A screening test with high negative predictive value could improve diagnostic accuracy
for acute appendicitis and reduce the number of patients needing imaging studies and
consultation. In a prospective pilot study, researchers evaluated whether S100A8/A9, a
calcium-binding protein that is secreted in inflammatory conditions, is a useful biomarker
for acute appendicitis. The study was conducted by the manufacturer of the biomarker
assay.

Plasma levels of S100A8/A9 and total white blood cell (WBC) counts were measured in
181 adults and children who presented to three emergency departments with right-sided
or infraumbilical acute abdominal pain of less than 2 weeks' duration and no dysuria or
recent trauma. The prevalence of acute appendicitis was 23%. For predicting acute
appendicitis, S199A8/A9 (at a cutoff of 20 units) had a sensitivity of 93%, specificity of
54%, negative predictive value of 96%, and positive predictive value of 37%.
Corresponding values for total WBC count (at a cutoff of 10 to the third power) were
62%, 67%, 86%, and 36%.

Comment: These preliminary data show promise for the S100A8/A9 test in patients with
possible acute appendicitis, but the findings of this pilot study must be validated in a
prospective trial. This study also shows, yet again, the futility of the outdated and
discredited — but surprisingly persistent — practice of using WBC count to diagnose
appendicitis.