16. laparascopic appendectomy 1.pptx

LAPAROSCOPIC
APPENDECTOMY
Facilitator: Dr. Hibaaq Mohamoud
Resident-G/Surgery
Moderator: Dr. Ringo (MD,MMED,MSC)
01/06/2023 Dr Hibaaq-laparascopic appendectomy

Session Objective
• We expect at the end; each participant will be able
• To describe the steps of laparoscopic
appendicectomy

The position of the patient
The patient is placed in the
supine position, combined
with;
Trendelenburg position
Left lateral position (10–150,
inclined towards the
surgeon)
Right arm extended for intravenous and blood
pressure cuff access by the anesthesiologist
Left arm with the pulse oximeter is tucked in at
the patient’s side

Set up for lap
appendectomy

Ready for lap appendectomy
6/1/2023 Dr.Rama-Laparoscopic appendectomy 7

Laparoscopic appendectomy cont…
Operative preparation
• Urethral catheterization: to decompress the bladder to avoid injury
while inserting the suprapubic ports.
• NGT
• The abdomen is prepped and draped in the routine manner.

Position of trocars and instruments
• Pneumoperitoneum: Established through the
umbilicus with Veress needle or Hasson cannula or
trocar.
• The videoscope is attached to the telescopic
instrument
• The system white-balance and the focus adjusted

Operating instruments:
• The operation is performed with four (4) permanent instruments:
• Grasping forceps
• Hook
• Scissors
• Needle holders with a single needled 2-0 cotton thread

• The patient in Trendelenburg position.
• Right side of the operating table may be elevated to
hold the small bowel away from the right lower
quadrant.
• Inspect the abdominal cavity thoroughly

• If the surgeon cannot obtain complete visualization of
the appendix, mesoappendix, and base of the cecum
for a safe transection, the operation is converted to
an open procedure

• The surgical technique consists of doing the following steps:
• Exposure of appendix
• Control of mesentery
• Division of appendix base
• Extraction of specimen
• Suction and irrigation

Step 1
• Hold the ileocecal appendix with grasping forceps introduced through
right iliac fossa 5mm port.

Visualization and upward retraction of
appendix

Step 2
• A dissecting forceps placed through the left iliac port
creates a window in the mesoappendix at the
appendiceal base.
• Caution should be taken not to injure the appendiceal
artery during this manoeuvre

Options for ligation of mesoappendix
• Clips
• Endoloop ligatures
• Linear intestinal staplers

Step 3
• Suture the base of the appendix with the cotton
thread (needled 2-0 with 20 cm long)
• Two ligatures are placed 5 mm apart, close
to the caecum
• Leave the two sutures on the caecum end.

Step 4
• Removal of the apprehended appendix, pulling the
grasping forceps immediately after section into the
trocar

• Alternatively:
• Sterile specimen retrieval bag is placed into
the abdomen through a 12 mm suprapubic
trocar and the appendix placed inside.

View of completed appendectomy after
removal of the specimen

Step 5
• Suction and irrigation

Abdominal closure
• The abdomen is decompressed.
• The trocars removed.
• Routinely, only the 10-mm port sites require fascial closure.
• The skin is approximated with fine absorbable sutures.
• Adhesive skin strips and dry sterile dressings (Band-Aid bandages) are
applied.

Postoperative care
• The OGT or NGT is removed before the patient awakens from
anesthesia.
• The Foley catheter is discontinued as soon as the patient is alert
enough to void.
• Postoperative pain can be controlled with oral medications.

Postoperative care cont…..
• Most patients can be weaned from intravenous fluid
to simple oral intake within a day.
• Most patients are discharged home within a day or
two.

16. laparascopic appendectomy 1.pptx

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