Diffuse Dermal Angiomatosis of the Breast

Diffuse dermal angiomatosis is rare and usually considered a variant of reactive angioendotheliomatosis. It generally involves the extremities of patients with severe vascular disease and other comorbidities. Two patients with…Continue readingDiffuse Dermal Angiomatosis of the Breast

Targeted therapy

Targeted therapy is a type of cancer treatment that works differently to chemotherapy. Chemotherapy attacks all rapidly dividing cells in the body, but targeted therapy works by “targeting” those differences that…Continue readingTargeted therapy

Cancer treatment centres in Nepal

1.   B. P. Koirala Memorial Cancer Hospital (BPKMCH): BPKMCH is the first tertiary level cancer hospital in Nepal, which provides all types of cancer treatment services, such as surgical oncology,…Continue readingCancer treatment centres in Nepal

Treatment of breast cancer

Treatments are less invasive when breast cancer is detected at an early stage. Challenges for breast cancer treatment in Nepal include patient’s financial status (given the huge out-of-pocket expenditure), accessibility…Continue readingTreatment of breast cancer


Disclaimer Articles, videos, online books, pictures,online videos, Exam Information, MCQs and Related topics in this medicospase is entirely intended  for study and general information purpose . Medicine and its updates…Continue readingDisclaimer

33 surgery recentadvance

Appendicectomy steps of operation


  • Prophylactic antibiotics
  • Bladder should be empty
  • General Anaesthesia
  • WHO time out
  • Position Supine – may need head down
  • Antiseptic dressing and draping


  • 10mm Umbilical port open technique – insert camera in – will be working port later
  • 5mm suprapubic
  • 5mm Left iliac fossa


  • 5 mm Camera in LIF port after insertion of all ports
  • Working ports suprapubic and umbilical
  • Perform diagnostic laparoscopy look for other causes e.g. pelvic organs, Meckels diverticulum
  • Aspirate fluid pus if present and sent for C/S
  • Expose appendix – may need head down, right side up
  • This is difficult in the video presented


  • Free appendix from tip to the base . Held appendix and divide mesoappendix close to appendix wall using diathermy. The division of mesoappendix may need clip or suture in the mesoappendix depending upon inflammation and anatomy – In this video there is application of haemolock. In easy appendices this is easily done by diathermising the mesoappendix close to appendix wall.
  • If there is any faecolith spillage as in this video make sure this is collected in Birt bag to prevent loosing this in the peritoneal cavity.


  • Apply endoloop to appendix base
  • Divide appendix and collect in Birt bag
  • Remove appendix and Birt bag via umbilical port
  • Wash out using generous amount of normal saline as in this case particularly if the appendix is inflamed like this
  • Drain has been placed here due to presence of pus and bad inflammation but this is not necessary in most instances
  • Close umbilical fascia using 1/0 vicryl or 1/0 PDS
  • Inject 20 ml marcaine 0.5%
  • Close skin
  • Antibiotics may be indicated further if pus present as in this case



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