"In the early 1990s all of our appendectomies were performed open," said Starship paediatric surgeon Steve Evans, "but now around 97 per cent are done laparoscopically."
Laparoscopy involves doing abdominal surgery through several small incisions for narrow surgical tubes rather than through the one larger cut required for the surgeon to see and do the operation in the traditional open procedure.
In laparoscopy, the surgeon sees what the business end of the instruments are doing via a video camera on one of the surgical tubes; the image is displayed on a screen at the bedside.
The surgical scars are generally tiny by comparison with open surgery and patients suffer less post-operative discomfort. For some laparoscopic operations, patients may recover faster and spend less time in hospital, although sometimes the surgeon has to switch to open surgery part-way through because of factors such as a patient's anatomy being more complex than expected.
At Starship, the Auckland-based national children's hospital, about 250 to 300 young people each year have their appendix removed.
It was the seventh most common primary procedure done in Starship's theatres in the 12 months to the end of June. Of the 8409 "theatre events" - some patients have more than one procedure done at the same time - the most frequent was sampling spinal fluid, followed by examinations of the airways and/or lungs.
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Mr Evans said many hospitals still routinely performed open appendectomies - and sometimes they were unavoidable - but Starship surgeons believed the keyhole version produced a better cosmetic result, "and our infection rate is much less. Up to 20 to 25 per cent of open appendectomy wounds can get infected, versus, in our hands anyway, fewer than 5 per cent [with keyhole surgery].
"Recovery may not be much quicker, however, because it is the disease that tends to determine the length of stay in hospital rather than the operation ... A nasty appendix needs a longer antibiotic course and patients tend to take longer to get back to normal diet and mobility."
Mr Evans said Starship's laparoscopic instruments were top quality. But the technology for displaying and recording the surgical images had fallen behind and was being replaced, as part of the upgrading of the theatres suite, with equipment that would reduce surgeon fatigue, increase efficiency and patient safety and help to reduce waiting lists.
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He cited another type of operation, involving the stomach and oesophagus, in which the laparoscopic version allowed patients to go home earlier than with the open technique.
He said that in terms of non-urgent surgery, it was now generally accepted that using laparoscopy to do this procedure, called fundoplication, was the best approach.
The operation is done to prevent acid reflux from the stomach into the oesophagus, a condition which can cause heartburn. It involves strengthening the valve at the bottom of the oesophagus.
Mr Evans said the open method required a large upper-abdominal incision. It was painful and could be associated with an increased risk of post-operative chest infections. The laparoscopic version was equally successful, but with a better cosmetic appearance, less post-operative pain, quicker mobilisation by patients and earlier discharge from hospital.
Surgeons the stars of starship for sisters
To Janice Simmons, the staff of Starship's theatres are the "Heroes of Hope" for the life-saving operations they have performed on her two daughters.
Grace, 15, has been to the operating theatres about 10 times for major operations and some minor procedures. Fourteen-year-old Brenna's tally is six.
The Mt Albert girls have both had tumours, but their diseases are unrelated, Ms Simmons says.
Brenna had a malignant brain tumour, diagnosed in 2009 following headaches and vomiting. She also had problems with her vision and it was an eye specialist who referred her to Starship.
Grace, 15, and Brenna, 14, Simmons have had numerous surgeries to deal with tumours and are now appealing to the public to support the operating theatres at Starship Children's Hospital. Photo / Greg Bowker
"Knowing what I had just been through with Grace, they said to take her in immediately. They did a CAT scan which showed a golf-ball sized tumour at the back of her brain."
Brenna had surgery to remove it, followed by radiation therapy and chemotherapy. She is now in remission from cancer but has been left with growth problems from the chemotherapy, and some short-term memory loss which is slowly improving.
"She is on growth hormone treatment and I have to inject her each night. The chemo damaged her pituitary gland so she wasn't producing growth hormone."
Grace's condition, neurofibromatosis type 1, is caused by a genetic variation. Diagnosed when she was 6 months old, it caused her no major problems until she was 9 years old, when a large mass was found in her chest. She was having trouble breathing and swallowing as it had spread to her oesophagus and trachea. Grace had surgery and radiation therapy to reduce the size of the tumour.
She also has numerous other tumours on nerve sheaths - especially in her back, where they compress the spinal cord - and an abnormal spine curvature called scoliosis. Her surgeries have included several to remove tumours, placement of metal rods to reduce the scoliosis, the fusing of bones in her neck, and the placement and later removal of a feeding tube needed because of her difficulties swallowing.
The fusion surgery was needed to stabilise Grace's neck but it has left her with no head movement up, down or sideways. She also had a "halo" traction device screwed on to her head as part of earlier treatment.
"She's an amazing girl, she's had so much thrown at her," Ms Simmons says. "The last surgery [in February] knocked her. She's lost a little mobility after each surgery. She's at a point now with the restriction in her neck, she finds that a little bit difficult to cope with. She can walk around home but if she is in a seat for longer than 20 minutes she gets a lot of pain in her neck and shoulder area. If she's out for longer than 20 minutes she uses a wheelchair, to get to the mall or to church."
Grace, formerly a pupil of Mount Albert Grammar - her sister's school - is home-schooled, with help from the Northern Health School.
Her doctors say her health outlook is uncertain.
"They usually say they can't answer that," her mother says. "The disease just progresses. They are hopeful that by the time she's 18 things will slow down. During puberty the tumours grow quickly."
A treat for Grace, each time she has an operation, is to have a streak of hair dyed a bright colour. Cobalt blue - her favourite - was her most recent choice.
Grace urges people to consider donating to the Help Our Kids campaign for the upgrading and expansion of Starship's operating theatres "because they do a really good job with everything and they deserve to get a better place to do all of it."
Her mum says: "If not for the surgeons at Starship who knows what the outcome could have been. The surgeons and everyone to do with the operating theatre area have just been outstanding, so amazing with both my girls.
"To me, they are the Heroes of Hope."
Fundraising continues
Readers have responded so well to our Help Our Kids campaign that we are going to keep raising funds to help with the redevelopment of Starship theatres.
During the next few weeks we will continue to highlight stories about the children who have been treated at Starship, an update on how the redevelopment project is going and more about the work the dedicated team at Starship do on a daily basis.
Thank you so much for your ongoing support.
For the Herald's full coverage of the Help Our Kids campaign click here.
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