Appendectomy, laparoscopic

  1. Trocar positioning

    Trocar positioning
    1. The author demonstrates two possible trocar positions. As demonstrated here, the 12 mm trocar is inserted in the umbilicus, the 5 mm trocar in the midline superior to the pubic symphysis and a pararectal 10 mm trocar in the LLQ.
    2. Optionally, the 10 mm and 5 mm trocar may be placed at the pubic hairline in the RLQ and LLQ.
  2. Instruments, minilaparotomy

    Instruments, minilaparotomy

    Infraumbilical incision, minilaparotomy and insertion of the camera trocar under camera view after placement of fascial stay sutures.

  3. Pneumoperitoneum, exploration

    Pneumoperitoneum, exploration

    Establish the pneumoperitoneum. The pressure level should reflect size, age and sex of patient (6–8 mmHg in children, 10–14 mmHg in adults). Limit the CO2 flow rate to 1 mL/min.

    Laparoscopy always starts with the abdominal exploration! This case presents with acute suppurative appendicitis with inflammatory adhesions to the anterior abdominal wall. 

    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).

  4. Working trocars, mobilizing the appendix

    Working trocars, mobilizing the appendix

    Under camera view, place a  pararectal 10 mm trocar and a suprasymphyseal 5 mm trocar. Administer local anesthetic to each trocar site prior to its incision.

    Mobilize the appendix bluntly with a swab and put the appendix under gentle traction with laparoscopic Babcock forceps or the like.

  5. Transecting the mesoappendix

    Transecting the mesoappendix

    Transect the mesoappendix with monopolar cautery to its base and close off the appendicular artery with titanium clips.

Transecting the appendix

Insert the Endo GIA™ (30 mm, blue magazine) through the 12 mm trocar and transect the appendix. The

Activate now and continue learning straight away.

Single Access

Activation of this course for 3 days.

€4.99 inclusive VAT

Most popular offer

webop - Savings Flex

Combine our learning modules flexibly and save up to 50%.

from €3.29 / module

€39.50 / yearly payment

price overview

general and visceral surgery

Unlock all courses in this module.

€9.08 / month

€109.00 / yearly payment