Laparoscopic Appendectomy Periprocedural Care

Updated: Aug 28, 2017
  • Author: Yevgeny Shuhatovich, DO; Chief Editor: Kurt E Roberts, MD  more...
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Periprocedural Care

Equipment

Before the procedure begins, all equipment must be present in the surgical arena and must be checked for proper working capacity. All methods of laparoscopic appendectomy require the standard laparoscopic equipment, including the following:

  • Trocars
  • Blunt graspers
  • Hook electrocautery
  • Laparoscope, 30º, 10 mm
  • Electrosurgical device (eg, electrocautery wand, Harmonic Scalpel [Ethicon, Somerville, NJ], Sonosurg [Olympus, Hamburg, Germany])

The following equipment, if available, is also helpful:

  • Laparoscope, 30º, 5 mm
  • Laparoscopic clip applier
  • Endocopic gastrointestinal anastomosis (Endo-GIA) 45-mm stapler, white cartridge
  • Suction irrigator
  • Endoscopic ligatures (Endoloop; Ethicon, Somerville, NJ)
  • Endoscopic retrieval bag

Many different approaches to laparoscopic appendectomy exist, all of which involve ligating the mesoappendix, transecting the appendiceal base, and retrieving the surgical specimen; the authors' method of achieving this is presented in the Technique section.

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Patient Preparation

Because of the inherent surgical technique and requirements, general anesthesia is the preferred method in performing a laparoscopic appendectomy.

Administer preoperative antibiotics to cover gram-negative and anaerobic bacteria.

Place the patient supine and tuck the left arm for initial peritoneal access. A single monitor is best positioned to the right of the patient, along the line of the right anterior superior iliac spine (ASIS). Upon abdominal insufflation and laparoscope insertion, steep Trendelenburg positioning allows proper placement of the last two trocars. After all of the trocars have been placed, placing the patient with the left side down aids gravity in relocating the small bowel away from the appendiceal/cecal field of vision.

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