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Appendectomy, laparoscopic - general and visceral surgery
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Instruments, draping, minilaparotomy
Establish the pneumoperitoneum.
The pressure level should reflect size, age and sex of patient (6–8mmHg in children, 10–14mmHg in adults). Limit the CO2flow rate to 1mL/min.
The video demonstrates acute appendicitis. Laparoscopy always starts with the abominal exploration! In the video, first the right lower quadrant is explored, then the right upper quadrant, left upper quadrant, again the area of the appendix, and finally the lesser pelvis. The lower abdominal organs are inspected in the numerical order of the sketch: Inspection around the appendix is followed by uterus and bladder (A), Douglas pouch (B), left ovary (C), and deep inguinal orifice (D). This is continued to the right groin area (E). Then the laparoscope is directed into the right upper quadrant (5) where the gall bladder (F) and right hepatic lobe (G) are inspected. This is followed by inspection of the left upper quadrant: Spleen and gastric corpus (H) as well as left hepatic lobe with falciform ligament, stomach and greater omentum (I).
Working trocars, freeing the cecum
Dissecting and resecting the appendix
Bluntly dissect the mesoappendix close to the base of the appendix with Overholt forceps (in video with scissors).
Insert the Endo GIA™ (linear stapler, 30 mm, white cartridge) via the 13.5mm trocar and resect the appendix.
Note: In the video, the"safe” way of resection is taken. Of course, the appendix may also be resected without a linear cutter, e.g., with a Roeder loop.
Transecting the mesoappendix, irrigation, suction
Transecting the mesoappendix (2ndcartridge).
The mesoappendix may also be transected with diathermy (caution: risk of secondary bleeding).
Only explore for Meckel diverticulum if the appendix appears rather unremarkable.
In Meckel diverticulum:
Resect the diverticulum sufficiently far from its base with a linear cutter (e.g., Endo GIA™ blue 30mm or 45mm cartridge) (not shown in video).
Check for any bleeding. Irrigate and suction the surgical field, particularly the Douglas pouch (evacuate it!).
Retrieving the appendix
Removing the specimen retrieval bag and trocars
Fascial suture, skin suture, dressing