Table 3 .

Likert scale of the likelihood of the use of the laparoscopic approach for seven common emergency surgical scenarios depending on various patient and environmental factors

Scenario 1: A patient with suspected appendicitis. They have no significant comorbidities. You decide to operate. How likely are you to approach this laparoscopically?
Patient	Never		Rarely		Sometimes		Frequently		Always
	(n)	(%)	(n)	(%)	(n)	(%)	(n)	(%)	(n)	(%)
a) 6-yr-old female	61	40.4	14	9.3	14	9.3	16	10.6	45	29.8
b) 12-year-old male	23	15.2	12	7.9	15	9.9	42	27.8	58	38.4
c) 25-year-old female	3	2.0	0	0.0	0	0.0	14	9.3	133	88.1
d) 65-year-old male	3	2.0	4	2.6	8	5.3	31	20.5	104	68.9
Scenario 2: A 50-year-old male with a computed tomography diagnosed perforated duodenal ulcer. You decide to operate. How likely are you to approach this laparoscopically?
Patient	Never		Rarely		Sometimes		Frequently		Always
	(n)	(%)	(n)	(%)	(n)	(%)	(n)	(%)	(n)	(%)
a) No significant comorbidities	37	24.5	20	13.2	31	20.5	30	19.9	32	21.2
b) ASA grade 3	43	28.5	27	17.9	28	18.5	32	21.2	20	13.2
c) Body mass index 42kg/m2	42	27.8	26	17.2	28	18.5	32	21.2	22	14.6
d) Previous abdominal surgery	51	33.8	34	22.5	41	27.2	12	7.9	12	7.9
e) Evidence of small bowel dilatation on CT	59	39.1	38	25.2	33	21.9	14	9.3	6	4.0
Scenario 3: A 60-year-old female with Hinchey grade 3 diverticulitis diagnosed on computed tomography. You decide to operate. How likely are you to approach this laparoscopically?
Patient	Never		Rarely		Sometimes		Frequently		Always
	(n)	(%)	(n)	(%)	(n)	(%)	(n)	(%)	(n)	(%)
a) No significant comorbidities	43	28.5	26	17.2	39	25.8	30	19.9	12	7.9
b) ASA grade 3	50	33.1	29	19.2	36	23.8	29	19.2	6	4.0
c) Body mass index 42kg/m2	56	37.1	29	19.2	34	22.5	24	15.9	7	4.6
d) Previous abdominal surgery	66	43.7	36	23.8	30	19.9	16	10.6	2	1.3
e) Evidence of small bowel dilatation on CT	73	48.3	41	27.2	23	15.2	11	7.3	2	1.3
Scenario 4: 60-year-old female with Hinchey grade 4 diverticulitis diagnosed on computed tomography. You decide to operate. How likely are you to approach this laparoscopically?
Patient	Never		Rarely		Sometimes		Frequently		Always
	(n)	(%)	(n)	(%)	(n)	(%)	(n)	(%)	(n)	(%)
a) No significant comorbidities	92	60.9	29	19.2	18	11.9	8	5.3	3	2.0
b) ASA grade 3	97	64.2	29	19.2	17	11.3	5	3.3	2	1.3
c) Body mass index 42kg/m2	96	63.6	33	21.9	15	9.9	4	2.6	2	1.3
d) Previous abdominal surgery	104	68.9	28	18.5	12	7.9	4	2.6	2	1.3
e) Evidence of small bowel dilatation on CT	106	70.2	29	19.2	10	6.6	3	2.0	2	1.3
Scenario 5: You have performed a laparoscopic repair of a perforated duodenal ulcer. Two days later the patient deteriorates on the ward. Computed tomography shows a large amount of free fluid and free air. You decide to operate. How likely are you to approach this laparoscopically?
Patient	Never		Rarely		Sometimes		Frequently		Always
	(n)	(%)	(n)	(%)	(n)	(%)	(n)	(%)	(n)	(%)
a) No significant comorbidities	74	49.0	16	10.6	27	17.9	19	12.6	13	8.6
b) ASA grade 3	82	54.3	20	13.2	24	15.9	15	9.9	8	5.3
c) Body mass index 42kg/m2	81	53.6	17	11.3	21	13.9	21	13.9	9	6.0
d) 50-year-old male	79	52.3	15	9.9	25	16.6	19	12.6	11	7.3
e) 80-year-old male	90	59.6	17	11.3	19	12.6	15	9.9	8	5.3
Scenario 6: A patient has had a laparoscopic anterior resection four days ago (primary anastomosis and not defunctioned). Today they have deteriorated and computed tomography shows a probable leak at the anastomosis. You decide to operate. How likely are you to approach this laparoscopically?
Patient	Never		Rarely		Sometimes		Frequently		Always
	(n)	(%)	(n)	(%)	(n)	(%)	(n)	(%)	(n)	(%)
a) No significant comorbidities	68	45.0	19	12.6	24	15.9	23	15.2	15	9.9
b) ASA grade 3	72	47.7	22	14.6	21	13.9	23	15.2	11	7.3
c) Body mass index 42kg/m2	73	48.3	23	15.2	21	13.9	23	15.2	8	5.3
d) 50-year-old male	71	47.0	18	11.9	24	15.9	21	13.9	15	9.9
e) 80-year-old male	76	50.3	22	14.6	20	13.2	23	15.2	8	5.3
Scenario 7: A patient presents with small-bowel obstruction confirmed on computed tomography. They have had no previous surgery and the radiologist reports an abrupt transition point in the pelvis. You decide to operate. How likely are you to approach this laparoscopically?
Patient	Never		Rarely		Sometimes		Frequently		Always
	(n)	(%)	(n)	(%)	(n)	(%)	(n)	(%)	(n)	(%)
a) No significant comorbidities	39	25.8	31	20.5	39	25.8	30	19.9	20	13.2
b) ASA grade 3	42	27.8	25	16.6	43	28.5	28	18.5	11	7.3
c) Body mass index 42kg/m2	47	31.1	28	18.5	37	24.5	22	14.6	15	9.9
d) 50-year-old male	39	25.8	24	15.9	39	25.8	27	17.9	20	13.2
e) 80-year-old male	47	31.1	27	17.9	36	23.8	23	15.2	15	9.9
f) A patient who has had previous open abdominal surgery	63	41.7	31	20.5	34	22.5	14	9.3	7	4.6

ASA, American Society of Anesthesiologists; CT, computed tomography