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Laparoscopic Appendectomy by George Crawford, MD
Authored by
George Crawford, MD
Authored by
George Crawford, MD
Laparoscopic Appendectomy by George Crawford, MD
Operative Steps
Operative Steps
- Patient is positioned, prepped, and draped. Access is generally obtained by making an incision in the umbilicus.
- Usually, a 12 mm trocar is used to enter the abdomen, and then lower pelvic 5 mm trocars are placed.
- The appendix is identified and retracted superiorly.
- The mesentery of the appendix is mobilized and transected using an energy device such as ENSEAL™ X1 Straight Jaw Tissue Sealer or HARMONIC™ 1100 shears.
- An endoscopic stapler, such as ECHELON™ 3000 Stapler, is fired across the base of the appendix and cecum taking care to not leave an appendiceal stump.
- Once completed, the appendix is placed in a specimen retrieval bag and removed through a 12 mm port.
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A drain is placed in the right lower quadrant if there are signs of perforation.
- The appendix is removed in the specimen retrieval bag through the 12 mm trocar site.
- A suture like a size 0 Vicryl™ Plus Antibacterial suture, is used to reapproximate the fascia of the umbilicus.
- The remaining trocars are removed. The wounds are closed using synthetic absorbable monofilament, such as Monocryl™ Plus Antibacterial suture, and a topical skin adhesive such as DERMABOND™ Mini Topical Skin Adhesive, or any appropriate dressing.
- The patient is extubated, the Foley is removed, and the patient is taken to the recovery room.
Potential complications include but are not limited to:
- Bleeding requiring reoperation
Note: If reoperation is necessary then an adjunctive hemostat such as SURGICEL SNoW™ or SURGICEL Powder™ might be a good option to control bleeding where primary methods (energy, staples, sutures, or clips) are ineffective or impractical.
- Surgical site infection (deep or superficial)
- Fecal fistula
- Conversion to open appendectomy
- Need for midline laparotomy
- Open wound
- Need for additional tests or procedures