1. LAPAROSCOPIC
APPENDECTOMY
Facilitator: Dr. Hibaaq Mohamoud
Resident-G/Surgery
Moderator: Dr. Ringo (MD,MMED,MSC)
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2. Session Objective
• We expect at the end; each participant will be able
• To describe the steps of laparoscopic
appendicectomy
01/06/2023 Dr Hibaaq-laparascopic appendectomy

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4. The position of the patient
The patient is placed in the
supine position, combined
with;
Trendelenburg position
Left lateral position (10–150,
inclined towards the
surgeon)
Right arm extended for intravenous and blood
pressure cuff access by the anesthesiologist
Left arm with the pulse oximeter is tucked in at
the patient’s side
01/06/2023 Dr Hibaaq-laparascopic appendectomy

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6. Set up for lap
appendectomy
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7. Ready for lap appendectomy
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8. Laparoscopic appendectomy cont…
Operative preparation
• Urethral catheterization: to decompress the bladder to avoid injury
while inserting the suprapubic ports.
• NGT
• The abdomen is prepped and draped in the routine manner.
01/06/2023 Dr Hibaaq-laparascopic appendectomy

9. Position of trocars and instruments
• Pneumoperitoneum: Established through the
umbilicus with Veress needle or Hasson cannula or
trocar.
• The videoscope is attached to the telescopic
instrument
• The system white-balance and the focus adjusted
01/06/2023 Dr Hibaaq-laparascopic appendectomy

10. Laparoscopic appendectomy cont…
Operating instruments:
• The operation is performed with four (4) permanent instruments:
• Grasping forceps
• Hook
• Scissors
• Needle holders with a single needled 2-0 cotton thread
01/06/2023 Dr Hibaaq-laparascopic appendectomy

11. Laparoscopic appendectomy cont…
• The patient in Trendelenburg position.
• Right side of the operating table may be elevated to
hold the small bowel away from the right lower
quadrant.
• Inspect the abdominal cavity thoroughly
01/06/2023 Dr Hibaaq-laparascopic appendectomy

12. Laparoscopic appendectomy cont…
• If the surgeon cannot obtain complete visualization of
the appendix, mesoappendix, and base of the cecum
for a safe transection, the operation is converted to
an open procedure
01/06/2023 Dr Hibaaq-laparascopic appendectomy

13. Laparoscopic appendectomy cont…
• The surgical technique consists of doing the following steps:
• Exposure of appendix
• Control of mesentery
• Division of appendix base
• Extraction of specimen
• Suction and irrigation
01/06/2023 Dr Hibaaq-laparascopic appendectomy

14. Step 1
• Hold the ileocecal appendix with grasping forceps introduced through
right iliac fossa 5mm port.
01/06/2023 Dr Hibaaq-laparascopic appendectomy

15. Visualization and upward retraction of
appendix
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16. Laparoscopic appendectomy cont…
Step 2
• A dissecting forceps placed through the left iliac port
creates a window in the mesoappendix at the
appendiceal base.
• Caution should be taken not to injure the appendiceal
artery during this manoeuvre
01/06/2023 Dr Hibaaq-laparascopic appendectomy

19. Options for ligation of mesoappendix
• Clips
• Endoloop ligatures
• Linear intestinal staplers
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21. Laparoscopic appendectomy cont…
Step 3
• Suture the base of the appendix with the cotton
thread (needled 2-0 with 20 cm long)
• Two ligatures are placed 5 mm apart, close
to the caecum
• Leave the two sutures on the caecum end.
01/06/2023 Dr Hibaaq-laparascopic appendectomy

23. Laparoscopic appendectomy cont…
Step 4
• Removal of the apprehended appendix, pulling the
grasping forceps immediately after section into the
trocar
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24. Laparoscopic appendectomy cont…
• Alternatively:
• Sterile specimen retrieval bag is placed into
the abdomen through a 12 mm suprapubic
trocar and the appendix placed inside.
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25. View of completed appendectomy after
removal of the specimen
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26. Laparoscopic appendectomy cont…
Step 5
• Suction and irrigation
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27. Abdominal closure
• The abdomen is decompressed.
• The trocars removed.
• Routinely, only the 10-mm port sites require fascial closure.
• The skin is approximated with fine absorbable sutures.
• Adhesive skin strips and dry sterile dressings (Band-Aid bandages) are
applied.
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28. Postoperative care
• The OGT or NGT is removed before the patient awakens from
anesthesia.
• The Foley catheter is discontinued as soon as the patient is alert
enough to void.
• Postoperative pain can be controlled with oral medications.
01/06/2023 Dr Hibaaq-laparascopic appendectomy

29. Postoperative care cont…..
• Most patients can be weaned from intravenous fluid
to simple oral intake within a day.
• Most patients are discharged home within a day or
two.
01/06/2023 Dr Hibaaq-laparascopic appendectomy

30. THANK YOU