Mayo stand and back table instruments for Laparoscopic Appendectomy surgery setup

Clamping & Occluding

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  Laparoscopic Clip Appliers

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  Curved Hemostat

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  Kelly Forceps

Cutting & Dissecting

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  L Hook Cautery

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  #3 Knife Handle

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  Laparoscopic Metz Scissor

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  Straight Mayo Scissor

Grasping & Holding

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  Toothed Forcep

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  Standard Laparoscopic Grasper

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  Laparoscopic Babcock Forceps

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  Laparoscopic Hunter Bowel Grasper

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  Laparoscopic Wave Grasper

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  Laparoscopic Fenestrated Grasper

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  Adson Forceps

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  Non toothed Pickup

Misc

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  Laparoscope

Retracting & Exposing

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  Army-Navy Retractor

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  Hasson S Retractor

Suctioning

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  Suction Irrigator

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  Yankauer Suction

Suturing & Stapling

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  Mayo-Hegar Needle Holder

What to expect during Laparoscopic Appendectomy

A laparoscopic appendectomy is a surgical procedure to remove the appendix, a small organ located in the lower right side of the abdomen. This surgery is commonly performed to treat appendicitis, a condition in which the appendix becomes inflamed and infected. The laparoscopic approach involves making small incisions in the abdomen and using specialized instruments to remove the appendix. This technique typically results in less pain, a shorter hospital stay, and a quicker recovery time compared to traditional open surgery.

Misc instruments
Verres needle, Endopouch, Endoloop, Culture Tubes

Equipment
ESU, suction, CO2 tubing, camera, light cord, trocars, video monitors, 

Drapes
Folded towels, laparotomy drape

Step 1: Incision and CO2 introduction
During a laparoscopic appendectomy, the first step is to make approximately 3-4 incisions with a scalpel. These incisions are made to insert trocars into the abdomen. A Verres needle may then be used to introduce CO2 into the abdomen. To insert the Verres needle, a Kelley and two towel clips should be available. After inserting the Verres needle, a syringe of saline may be needed.

Step 2: Trocar insertion and dissection
Another method is to insert a trocar and then attach the CO2 tubing to achieve pneumoperitoneum. Once the abdomen is inflated, fat or adhesions can be dissected with graspers, hook cautery, and Maryland. To retract during the insertion of trocars, S retractors or Army-Navys may be used.

Step 3: Finding the appendix and ligation
The cecum will be found using an instrument that won’t cause damage, and the appendix will be at the end of it. Using a laparoscopic stapler, the appendix as well as the artery in the appendix will be ligated, and the appendix will then be amputated. The stump left behind from the appendix is then usually cauterized to avoid bleeding.

Step 4: Amputating the appendix with suture loop
Another way of amputating the appendix is to use a suture loop and then laparoscopic scissors. The appendix will then be removed through one of the trocars.

Step 5: Closing port sites
CO2 gas is then released from the abdomen, and the trocars will be removed. To suture the port sites, a needle driver and an adson pick-up will be needed, and the straight mayo scissors should be available for cutting suture. Finally, the port sites will be closed.

Tips and tricks
An endopouch may be used if the appendix is inflamed. Cultures may be taken depending on severity. Isolate instruments that come in contact with the amputated appendix to preserve sterility. 

The Surgery Sparknotes

1. Make 3-4 incisions with scalpel to insert trocars
2. Use Verres needle for CO2 introduction with Kelley and two towel clips
3. Dissect fat or adhesions with graspers, hook cautery, and Maryland
4. Find appendix and ligate using laparoscopic stapler
5. Amputate appendix and cauterize stump
6. Or amputate using suture loop and laparoscopic scissors
7. Remove appendix through trocar and close port sites with suture