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Laparoscopic Appendectomy by Dr Andrew Renaut

Laparoscopic Appendectomy Steps

Step 1: Port placement: A 10-mm trocar is placed at the umbilicus, and the abdominal cavity is insufflated to a pressure of 15 mmHg. The camera is also inserted through this larger trocar.

A 5-mm trocar is placed at the suprapubis, and a second 5-mm trocar is placed at the LLQ.

Step 2: Inspect abdominal cavity: The area is inspected to orient the surgeon to the position of the appendix.

Step 3: Expose appendix: The bowel is gently retracted rostrally using atraumatic graspers to allow access to appendix.

Step 4: Locate and separate appendicular artery: The mesoappendix is separated from the body of the appendix, and the mesenteric fat is separated to reveal the appendicular artery. This is best done using the “spreader” action of a dissector.

Step 5: Divide appendix from cecum: Using an endoloop, two loops are placed proximal to the cecum, and a third loop is placed 1-2 cm distally to these. The appendix is then divided between the two proximal and 3rd distal loops using scissors or cautery.

Step 6: Extract appendix: The camera may be withdrawn and the existing 10 mm port used for extraction

Step 8: Irrigate: The abdominal cavity should be irrigated thoroughly with sterile saline and suctioned clean several times. In the event of a rupture, great care should be taken to ensure all pus or other infectious fluids have been removed.

Step 9: Final inspection: The abdominal and pelvic cavities are inspected one final time for any signs of infection, errors, or other potential complications.

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