Without Complications and Scars: In Israel, Appendices are Removed from Children Through a Small Puncture

Minimal trauma, reduced blood loss and risk of postoperative complications, shorter hospitalization periods, and rapid recovery – the modern surgical technique that involves performing interventions through natural openings in the body, without incisions, is now used for children and adolescents. In the Israeli hospital Ichilov, the operation to remove the appendix from a young girl was performed for the first time using a single tiny puncture in the navel.

17-year-old Ora Avishar became the first Israeli teenager to undergo surgical treatment for appendicitis using this state-of-the-art technique. "This is an innovative surgical method that is currently used only in Ichilov among Israeli hospitals for children and adolescents under 18 years old," explains Professor Igor Sukhotnik, head of the pediatric surgery department at the Dana-Dueck Pediatric Clinic, part of the Tel Aviv medical center. "It allows for interventions through a single incision in the abdominal wall."

"The doctors said I was the first in Israel to have an inflamed appendix removed using the new method, and that I wouldn't have an unpleasant memory in the form of a scar," says Avishar. "I was happy to hear that." The intervention was successful, and the patient is now home and recovering quickly.

Ora needed surgical treatment after two unsuccessful attempts to treat appendicitis with medication. The problem first arose last summer when the girl was relaxing by the pool with her brothers. "Suddenly, I felt a sharp pain in my right side. Within minutes, I was literally writhing in pain," she recalls.

Her parents immediately took her to the emergency medical service. After a series of tests and necessary examinations, the verdict was made – appendicitis. However, since the inflammation was mild, the doctors assured that they could manage it with medication. For five days, the girl received intravenous antibiotics and analgesics, after which she was discharged home. "At that time, I thought this story was over," she recalls. "But a month later, the pain returned." Everything repeated according to the familiar scenario: hospital, tests, three-day hospitalization, medication treatment, relief. As it turned out, it was again temporary.

At the end of autumn, Ora was planning to fly to Spain with her family to celebrate her birthday, but the day before, she suddenly developed a fever and abdominal pain. "I immediately realized that appendicitis had returned, and the intensity of the pain indicated that this time the situation was much more serious," says the girl. "So I found myself in the hospital for the third time."

The teenager was hospitalized in the pediatric surgery department of the Tel Aviv hospital Ichilov. The doctors decided to perform the operation for the first time using the new method that leaves no scars on the body. "Leading clinics around the world have long used laparoscopy for both adults and children, but we used an improved method that allowed us to remove the appendix through a single tiny incision in the navel area," notes Professor Sukhotnik.

Laparoscopy is a minimally invasive surgical method that became widely used in the 1990s. During such an operation, the surgeon makes three to four small incisions – up to one and a half centimeters in diameter – in the abdominal wall. Through these incisions, he introduces a laparoscope – a thin tube with a lens system, optical cable, and a miniature video camera, as well as microsurgical instruments. The image from the camera is transmitted to a monitor screen located opposite the surgeon and is magnified multiple times, allowing him to perform the necessary manipulations more accurately.

The advantages of this approach are obvious. It causes the patient less surgical trauma, is accompanied by ten times less blood loss, rarely leads to complications, significantly reduces the risk of postoperative hernias, and requires a shorter rehabilitation period. Moreover, such operations are painless for most people and do not leave noticeable scars on the body. All this has given laparoscopy the status of a preferred method for certain interventions.

Nevertheless, for all these years, doctors have been trying to improve this technique, further reducing its invasiveness. As a result, the number of incisions has been reduced to one, which is made through natural openings in the body. For example, interventions on the spleen, small intestine, liver, and pancreas have begun to be performed through a puncture in the navel, as well as the removal of tumours from the abdominal cavity and pelvis, and the correction of hernias.

At that time, the new access was also used in gynecology for the removal of the uterus. Shortly thereafter, neurosurgeons adopted it – they began to perform resections of brainstem tumours through a tiny incision in the nose, which was a real breakthrough.

"All this time, however, operations with access through natural openings in the body were performed only on adult patients, and the admissibility of using the new method in pediatric surgery was debated for a long time," says Professor Sukhotnik, who was one of the first to implement advanced techniques in Israel. "But we took the plunge. Since it was a very young girl, we wanted to minimize the cosmetic defect after the intervention. As a result, the patient was left with a two-centimeter scar, which will become invisible over time."

"When I woke up after the operation, I didn't feel any pain, I was just upset about the canceled trip to Spain," recalls Avishar. "But the next day my mood improved, I was allowed to get out of bed, and I felt my strength returning. I still can't work out in the gym or play sports, but as the doctors say, it won't be long. The main thing is that the only reminder of the intervention today is a tiny scar near the navel, which will disappear after a while."

Today, minimally invasive surgeries with access through natural openings in the body for children and adolescents have become routine practice in the largest medical centers around the world. In Israel, they will soon cease to be a rarity, assures Professor Sukhotnik, after pediatric surgeons master the new technique and hospitals acquire the special expensive equipment needed for such interventions.