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Laparoscopic treatment of an appendicular mucocele

This video shows the laparoscopic treatment of an appendicular mucocele in a female patient who had had a hysterectomy.

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Laparoscopic treatment of an appendicular mucocele

作者群

J Leroy, J Marescaux

摘要

This video shows the laparoscopic treatment of an appendicular mucocele in a female patient who had had a hysterectomy.

分類

basic techniques

關鍵字

laparoscopy, treatment, appendicular mucocele, appendectomy

媒體類型

手術影片

期間

05'00''

刊物

2008-09

普通的

最愛

Favorites Media

音訊

副標題

數位出版

WeBSurg.com, Sept 2008;8(09).
URL: http://www.websurg.com/doi-vd01en2388.htm

Laparoscopic treatment of an appendicular mucocele

1. Case presentation 00'01''

This video demonstrates the laparoscopic treatment of an appendicular mucocele in a 48-year-old female patient with a previous history of hysterectomy. She was diagnosed with a symptom-free tumor, 7cm in diameter, located in the right iliac fossa.

2. Exploratory laparoscopy 00'17''

We first perform the exploration of the pelvic cavity and demonstrate the presence of fluid, which is absolutely normal. We then inspect the ileocaecal region and notice that the appendix has increased in size and presents a pathologic aspect resembling to that of an appendicular mucocele.

3. Appendix identification and dissection (mesoappendix division) 00'44''

We decide to free the adhesions between the last ileal loop and the appendix using monopolar cautery. This division is continued up to the appendicular base by freeing the appendix totally within the caecal region.

4. Appendiceal base ligation and partial division 01'25''

We place a Vicryl suture that we introduce through the supra-umbilical port. This one is placed at the level of the appendicular base as can be seen here. A second suture is placed, this time at the level of the left iliac fossa. This suture will be placed at the same place than the first suture and it is knotted extracorporeally. This suture aims to reinforce the appendicular stump. The procedure is continued with the placement of a third Vicryl-type suture placed 1cm caudad to the previous one in order to avoid any fecal contamination. We first perform a small partial division of the appendicular base using scissors. We do not use cautery at this stage.

5. Division of the appendicular base 02'57''

Through 2 umbilical ports, we introduce an Endo-GIA extraction bag and place the specimen in it. The appendicular mucocele is introduced in the bag before completing the division of the appendicular base. We gently divide the appendicular stump using monopolar cautery. Once the division is complete, we go back to the operative field. We can observe minimal bleeding, which will be controlled using monopolar cautery. In the present case, we recheck the hemostasis of the operative field.

6. Specimen extraction 04'04''

The procedure ends with the extraction of the specimen. We close the bag before extracting it at the level of the umbilical port. Here we can observe how we perform the extraction at the umbilical level with an external camera. We first exert traction on the bag, then we perform a slight division of the specimen in order to aspirate and reduce the size of the appendix. Then with double traction, we can remove the specimen completely.