LAPAROSCOPIC APPENDECTOMY

Anaesthesia: General anesthesia Given.

Steps:-

The standard technique usually employs 3 ports, sometimes an additional port can be inserted in the
right upper abdomen for retraction .

insert the first 10 mm blunt tipped port above the umbilicus , the skin incision is made just large
enough to accommodate the cannula thereby preventing any gas leak from the trocar site .The first
5mm port is usually placed in the left iliac fossa taking care to avoid accidental injury to the inferior
epigastric vessels by trans illuminating the anterior abdominal wall. The second 5mm working port is
placed 2cm above the pubic symphysis in the midline.

After a quick general survey of the peritoneal cavity to detect unexpected pathology , the operating
table is titled to the left and the head end of the table is lowered .

The first step is to identify the cecum . if it is obscured by omental adhesions , these are dissected
away from the ileocecal area .the tenia coli are followed downward to reveal the location of the
appendix.

The appendix is gently grasped using a laparoscopic Babcock grasper and the extend of adhesions
is assessed .

The view to aim for, is one where the ileum , cecum and appendix are all seen clearly . Bipolar
electrosurgery or a harmonic scalpel used to create a window in the mesoappendix just adjacent to
the base of the appendix and ligate the mesoappendix with a free suture, other options for dividing
the mesoappendix are clips and stapler .

The appendix base can be secured using an commercial endoloop, a Roeder/Tayside knot prepared
in the operating room using 2-0 polygalactin , a free 2 handed ligature , laparoscopic titanium clips
(LT 400 usually ),vascular clips , and GI stapler .

Using endoloop – two of them towards the “stay” side and one on the “go” side is left slightly
longer to make extraction easier. Appendix is transected.

A small piece of ribbon gauze can be used to gently mop clean the area and apply a dab of povidone
iodine at the transected end of the appendix .

After checking for hemostasis , we bag the specimen , usually in a glove finger or a glove bag. It is
preferred to use a 5mm telescope through one of the 5mm ports at this stage of surgery and use the
larger port for extraction of the specimen.

The port sites are infiltrated with local anaesthetic at the conclusion of the procedure to further
minimize postoperative pain.

Port sites are closed with polyamide 2.0 suture and sterile dressing applied.