This document discusses port positions and ergonomics considerations for laparoscopic appendicectomy. It begins by noting that port placement depends on surgeon preference and ergonomic factors like patient age, build, and site of pathology. The principles of straight line access, triangulation and co-axial alignment between ports, surgeon, and camera are described. Recommended port positions are discussed for different patient populations like children, pregnant patients, and those with situs inversus anatomy. Alternative techniques like single incision laparoscopic surgery and natural orifice transluminal endoscopic surgery appendicectomy are also mentioned. The importance of ergonomics factors like instrument manipulation angle, elevation angle, and gaze angle are emphasized for efficiency and

1. Laparoscopic Appendicectomy
Port Positions and Importance of
Ergonomics
Dr.S.Easwaramoorthy
MS FRCS(Eng) FRCS (Glas) FRCS (Edin)
Head of Dept of Minimal Access Surgery
Examiner, RCS of Edinburgh
Executive Member, South Zone IAGES
IAGES Endoscopy Course Convener

2. Port placement for laparoscopic appendectomy with the best cosmesis
Surg Endosc. 2003 Jan;17(1):166-7

3. Port Positions
• Preference of surgeon
• Ergonomical reasons
– Age & build of the patient
– Site of pathology
• Clinical & imaging criteria
• Variable position of appendix

4. Ergonomics
• Straight Line principle
• Triangulation
• Manipulation angle
• Elevation angle
• Low lying table
• Gaze down view

5. Patient position and OT Set up
• Patient
– Lying supine, head down & right side up
• Surgeon & Assistant
– Standing on the patient’s left side

6. Straight Line Principle
Surgeon
Pathology
Monitor
Camera Asst

7. Triangulation &
Co Axial Alignment
C
S
C

8. Manipulation angle
Azimuth Angle
Manipulation Angle
30-45 degree
60-90 degree

9. S
C
R
L
P
N
C: Camera
S: Surgeon
N: Nurse

10. Bikini Line Ports
• Lt supra pubic port: Optical port
• Umbilical port: Rt hand dissection port
• Rt supra pubic port: Lt hand retraction port
S
CN

11. Appendicectomy In a Child
L
R
C
Camera Asst
Surgeon

12. Fulcrum Effect of Hand Instruments
1: 1

13. Along with Lap Cholecystectomy
C

14. During Pregnancy
1st
Trimester 3rd
Trimester

15. Situs Invertus
C
S
C
Monitor

16. 2 port appendicectomy
C

17. SILS Appendicectomy
Acute appendicitis can be treated with single-incision laparoscopy:
A systematic review of randomized controlled trials. Colorectal Dis. 2015 Apr;17(4):281-9
Meta-analysis of randomized trials on single-incision laparoscopic versus conventional
laparoscopic appendectomy. Am J Surg. 2014 Apr;207(4):613-22.

18. Transvagainal
NOTES Appendicectomy

19. Laparoscopic Appendicectomy
Port Position & Ergonomics

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