Laparoscopic Appendectomy
This procedure involves the surgical removal of an inflamed or infected vermiform appendix using a minimally invasive endoscopic approach. The appendix is mobilized from the cecum, its blood supply is ligated, and the organ is excised and removed through a cannula.
Surgical instruments
21 on this table — tap a photo to zoom, the name for its full card.
The case
Misc instruments
Verres needle, Endopouch, Endoloop, Culture TubesSpark notes
The 30-second rundown — scan this outside the room.
- Make 3-4 incisions with scalpel to insert trocars
- Use Verres needle for CO2 introduction with Kelley and two towel clips
- Dissect fat or adhesions with graspers, hook cautery, and Maryland
- Find appendix and ligate using laparoscopic stapler
- Amputate appendix and cauterize stump
- Or amputate using suture loop and laparoscopic scissors
- Remove appendix through trocar and close port sites with suture
Walkthrough
What the surgeon does — and what to have in your hand before they ask.
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.
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.
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.
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.
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.
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