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Laparoscopic appendectomy: standard technique

This video demonstrates an interval appendectomy in a patient with chronic appendicitis. It provides for good basic demonstration of the techniques involved using electrocautery and clips to divide mesoappendix and endoloops to control appendicular stump.

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Laparoscopic appendectomy: standard technique

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摘要

This video demonstrates an interval appendectomy in a patient with chronic appendicitis. It provides for good basic demonstration of the techniques involved using electrocautery and clips to divide mesoappendix and endoloops to control appendicular stump.

分類

routine cases

關鍵字

laparoscopy,appendix,removal,resection,operation,appendectomy

媒體類型

手術影片

期間

05'00''

刊物

2004-12

普通的

最愛

Favorites Media

音訊

副標題

數位出版

WeBSurg.com, Dec 2004;4(12).
URL: http://www.websurg.com/doi-vd01en1605.htm

Laparoscopic appendectomy: standard technique

1. Case presentation and trocar placement 00'10''

This video will demonstrate the technique used for laparoscopic appendicectomy. The case is that of a 24-year-old female patient who presented with chronic right flank pain. Preoperative ultrasound and barium enema revealed an ectopic vermiform appendix located in the subhepatic region. A Veress needle is used for insufflation and this is placed in the left subcostal region. Three ports are used in total, one near the umbilicus, one in the left iliac fossa, and one in the hypogastric area as shown.

2. Exploration and exposure 01'03''

Now to the laparoscopic exploration. A thorough exploration is performed to detect any abnormalities in the abdomen and the pelvis. Following exposure of the pelvis, a check is made in order to check for pelvic pathology. Here is the uterus and the ovarian elements which look normal. We now go to the ileocaecal area. We follow the terminal ileum back from the ileocaecal junction in order to check for a Meckel’s diverticulum. There doesn’t seem to be a Meckel’s diverticulum. Now to the appendix itself.

3. Control of mesoappendix 02'23''

The caecum is lifted in order to expose the base of the appendix. While grasping the appendix, the dissection of the mesoappendix is performed using a diathermy hook. The vessels can either be coagulated or isolated by dissection and then clipped. The dissection is continued as the meso is carefully separated from the appendix. Now to the alternative technique.

4. Alternative technique 03'19''

Again careful dissection is performed in order to isolate the appendix. The mesoappendix is controlled using clips.

5. Ligation and resection 03'52''

Once the appendix is isolated, an endoloop knot is placed close to the base of the appendix. The loop is then tightened as shown. A further endoloop is placed over the first endoloop. This is to ensure adequate sealing of the stump. A clip is then placed over this in order to prevent contamination when dividing the appendix. The appendix is then divided between the ligature and the clip, and removed through the operative trocar.

6. Extraction 04'54''

Following a dab of betadine on the stump for this infection, the omentum is brought over the area. A final check is made and this is the end of the operation.