Preparation:
- Prophylactic antibiotics
- Bladder should be empty
- General Anaesthesia
- WHO time out
- Position Supine – may need head down
- Antiseptic dressing and draping
Ports:
- 10mm Umbilical port open technique – insert camera in – will be working port later
- 5mm suprapubic
- 5mm Left iliac fossa
Steps:
- 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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