Should an Interval Appendicectomy Be Performed by a Minimally Invasive Gynaecologist?

Yael Yagur,1– 3 Sarah Choi,1,2 Jessica A Robertson,1,2 Orla Donohoe,1,2 Mohammed Almoqren,1,2 Danny Chou,1,2 David MB Rosen1,2 1Sydney Women’s Endosurgery Centre (SWEC), St George Hospital, Sydney, NSW, Australia; 2University of New South Wales, Sydney, NSW, Australia; 3School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, IsraelCorrespondence: Yael Yagur, Sydney Women’s Endosurgery Centre (SWEC), Suite 10b, Level 3, St George Private Hospital, 1 South St Kogarah, Sydney, NSW, 2217, Australia, Tel +610434174885, Email [email protected]: We aimed to explore the abnormal pathology findings in appendix specimens removed based on intraoperative abnormal appearance during elective surgery for benign gynaecological conditions by a minimally invasive gynaecologist, as well as the associated complication rate.Materials and Methods: This retrospective cohort study was conducted in a tertiary referral surgical centre for benign gynaecological conditions between the years 2004– 2023. It included patients who underwent appendicectomy by a trained minimally invasive gynaecologist based on observations during surgery for benign gynaecological conditions. Data included demographic, clinical, surgical and pathological information followed by postoperative complication data obtained from electronic medical records and direct communication with surgical colleagues. The primary outcome was the evaluation of the abnormal pathological findings in the appendix. The secondary outcome was the complication rate associated with appendicectomy in these cases.Results: The study cohort included 34 women who met inclusion criteria and underwent a laparoscopic surgery for endometriosis, chronic pelvic pain or a benign ovarian mass. Indications for appendicectomy included twelve cases (38.2%) with apparent appendiceal immobility (stiffness), fourteen cases (41.2%) with an appendix adherent to ovaries or the pelvic side walls, and seven cases (20.6%) with an abnormal appearance (large, wide, long, coiled, or curved). Pathological findings revealed six cases (17.6%) of acute or chronic appendicitis, four cases (11.8%) of endometriosis, five cases (14.7%) of abnormal pathological conditions, and three cases (8.8%) of cancer (two cases of well-differentiated adenocarcinoma and one case of low-grade appendiceal mucinous cystadenoma). Postoperative complication rate was 5.8% (two cases).Conclusion: This study supports incorporating appendicectomy by trained gynaecological specialists during gynaecological elective surgery when abnormal findings are encountered. Further research and guidelines in this area can provide even greater clarity and direction for the future of gynaecological surgical practice.Keywords: appendicectomy, cancer, minimally invasive gynaecology surgery, training