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Laparoscopic Appendectomy

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Laparoscopic Appendectomy
Technique
 
 Technical Difficulty Level =  3 - 4 MINIMAL
             

 

 STEP 1: Exposing the Appendix

A pneumo-peritoneum is created in the usual fashion. The trocars are inserted.

An atraumatic grasper [Endo Babcock or Dolphin Nose Grasper] is inserted via the right upper quadrant  trocar . The cecum is retracted upward toward the liver. In most cases, this maneuver will elevate the appendix in the optical field of the telescope. The appendix is grasped with a 5 mm claw-type grasper inserted via the supra-pubic trocar . It is held toward the abdominal wall.

 

 

 STEP 2: Creating the Mesenteric Window

A dolphin nose grasper  is used to create a mesenteric window under the base of the appendix. The window should be made as close as possible to the base of the appendix and should be approximately 1cm in size. 

 

 

 STEP 3: Transecting the Meso-appendix and Appendix

The appendix is transected by inserting a MULTIFIRE ENDOGIA 30™ instrument via the RUQ trocar (blue cartridge, 3.5), closing it around the base of the appendix and firing it.

 

The base of the appendix is inspected for hemostasis. The operator should wait a few minutes before initiating measures to stop any bleeding site on the staple line as it will most likely stop spontaneously. The MULTIFIRE ENDOGIA 30™ cartridge is changed to a vascular cartridge (white, 2.5) and the meso-appendix is  transected with the same instrument . Several cartridges may have to be used.

 STEP 4: Retrieving the Appendix

The appendix is now amputated from the gastrointestinal tract. A 10mm ENDOCATCH™ instrument is inserted via the RUQ trocar and deployed in the intra-abdominal cavity. The appendix, held by the grasper (via the suprapubic trocar), is placed into the specimen bag. The bag is closed and the ENDOCATCH™ instrument  is removed [with the trocar] from the intra-abdominal cavity. The ENDOCATCH™ instrument is separated from the trocar, and the trocar is reinserted.

The intra-abdominal cavity is irrigated thoroughly with normal saline . For perforated appendicitis with or without an intra-abdominal abscess, a Blake Drain™ is left in the right lower quadrant and pelvis.


 

Procedural Videos

> Lap-APPY: Standard / Full lenght

> Lap-APPY: Difficult with pelvic abscess.

> Lap-APPY: Difficult Exposure

> Lap APPY: Retrieving the Specimen

> Lap APPY: Retro-cecal / Retro-hepatic appendix


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