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
Endoscopic 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 is presented in the Technique section.

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.

Technique

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Media Gallery

Laparoscopic appendectomy. Procedure perfomed by Spencer Armory, MD, and James Lee, MD, ColumbiaDoctors, New York, NY. Video courtesy of ColumbiaDoctors (https://www.columbiadoctors.org).
Laparoscopic appendectomy. Suprapubic trocar insertion. Great care must be employed to avoid bladder injury.
Laparoscopic appendectomy. Case of acutely inflamed retrocecal appendix. Ultrasonic scalpel dissection to reveal appendiceal base/cecal base as indicated by confluence of taeniae coli.
Laparoscopic appendectomy. Ultrasonic scalpel is then used to cauterize and divide mesoappendix. Note excellent view of cecal/appendiceal base.
Laparoscopic appendectomy. Deployment of endoscopic loop around base of appendix.
Laparoscopic appendectomy. Division of appendix from cecum above two endoscopic loops.
Laparoscopic appendectomy. Suctioning and irrigation of surgical site and survey of dissection for hemostasis.

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Author

Yevgeny Shuhatovich, DO Resident Physician, Department of Surgery, Maimonides Medical Center

Yevgeny Shuhatovich, DO is a member of the following medical societies: American College of Surgeons, American Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Joseph Michael R Zuniga, MD Resident Physician, Department of Surgery, Maimonides Medical Center

Disclosure: Nothing to disclose.

Aleksander Bernshteyn, MD Chief Resident, Department of Surgery, Maimonides Medical Center

Disclosure: Nothing to disclose.

Evan Brad Goldstein, DO Assistant Professor of Surgery, Department of Surgery, State University of New York Downstate Medical Center College of Medicine; Attending Surgeon, Department of Surgery, Maimonides Medical Center

Evan Brad Goldstein, DO is a member of the following medical societies: American College of Surgeons, Association for Academic Surgery, Association of Program Directors in Surgery

Disclosure: Nothing to disclose.

Danny A Sherwinter, MD Attending Surgeon, Department of Mimially Invasive Surgery and Bariatrics, Associate Program Director, Department of Surgery, Maimonides Medical Center; Director of Minimally Invasive and Bariatric Surgery, American Society for Metabolic and Bariatric Surgery (ASMBS) Center of Excellence

Danny A Sherwinter, MD is a member of the following medical societies: American College of Surgeons, American Society for Metabolic and Bariatric Surgery, Society of American Gastrointestinal and Endoscopic Surgeons, Society of Laparoscopic and Robotic Surgeons

Disclosure: Nothing to disclose.

Harry L Adler, MD Assistant Clinical Professor of Surgery, Mount Sinai Hospital; Assistant Director and Consulting Physician, Maimonides Medical Center

Harry L Adler, MD is a member of the following medical societies: American Association for Physician Leadership, American College of Surgeons, Association for Academic Surgery

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Chief Editor

Kurt E Roberts, MD Associate Professor, Division of Bariatric and Minimally Invasive Surgery, Department of Surgery, Yale University School of Medicine; Chair, Department of Surgery, Saint Francis Hospital, Trinity Health of New England Medical Group

Kurt E Roberts, MD is a member of the following medical societies: American College of Surgeons, Society of American Gastrointestinal and Endoscopic Surgeons, Society of Laparoscopic and Robotic Surgeons

Disclosure: Nothing to disclose.

Acknowledgements

Jerzy M Macura, MD Chief of Advanced Laparoscopic Surgery, Director of Bariatric Surgery, Maimonides Medical Center

Jerzy M Macura, MD, is a member of the following medical societies: American Society for Metabolic and Bariatric Surgery, American Society of Abdominal Surgeons, and Society of American Gastrointestinal and Endoscopic Surgeons

Disclosure: Nothing to disclose.