Overview
Laparoscopic Appendectomy is a minimally invasive surgical procedure used to remove the appendix. It is the standard treatment for acute appendicitis and offers faster recovery compared to open surgery.
Laparoscopic appendectomy is crucial for treating acute appendicitis, preventing complications like perforation and abscess formation. It provides better visualization and reduced post-operative pain.
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Indications
Confirmed or suspected appendicitis
Inflammatory mass around appendix
Previous episodes of appendicitis
Drainage and appendectomy
During other abdominal procedures
Contraindications
Absolute Contraindications
Relative Contraindications
📋 Equipment Checklist
Check off items as you gather them:
Pre-procedure Preparation
Preparation includes patient consent, preoperative antibiotics, positioning, equipment setup, and team briefing. All team members should understand their roles.Step-by-Step Procedure
Step 1: Patient Preparation
Position patient, prep and drape, establish pneumoperitoneum.
⚠️ Common Mistakes to Avoid:
- Poor positioning
- Inadequate prep
- Wrong pressure
💡 Pro Tip:
Position patient supine with arms tucked.
Step 2: Port Placement
Insert ports: umbilical (10mm), RLQ (5mm), suprapubic (5mm).
⚠️ Common Mistakes to Avoid:
- Wrong port placement
- Port injury
💡 Pro Tip:
Use open technique for first port.
Step 3: Exploration
Systematically explore abdomen, identify appendix.
⚠️ Common Mistakes to Avoid:
- Incomplete exploration
- Missed pathology
💡 Pro Tip:
Always explore all quadrants.
Step 4: Mobilization
Mobilize appendix, divide mesoappendix.
⚠️ Common Mistakes to Avoid:
- Inadequate mobilization
- Bleeding
💡 Pro Tip:
Use energy device for mesoappendix.
Step 5: Ligation
Ligate appendix base with endoloop or stapler.
⚠️ Common Mistakes to Avoid:
- Incomplete ligation
- Stump leak
💡 Pro Tip:
Place ligature at base of appendix.
Step 6: Division
Divide appendix above ligature.
⚠️ Common Mistakes to Avoid:
- Wrong division site
- Stump too long
💡 Pro Tip:
Leave 2-3mm stump.
Step 7: Removal
Remove appendix through port, close ports.
⚠️ Common Mistakes to Avoid:
- Port site hernia
- Incomplete closure
💡 Pro Tip:
Close fascia for 10mm ports.
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Post-procedure Care
Post-procedure care involves monitoring for complications, early ambulation, pain management, and discharge planning when criteria are met.Complications & Management
| Complication | Incidence | Signs | Management | Prevention |
|---|---|---|---|---|
| Bleeding | 1-3% | Hemodynamic instability, decreasing Hb | Exploration, hemostasis | Careful dissection, energy device |
| Infection | 3-8% | Fever, wound erythema | Antibiotics, drainage | Preoperative antibiotics, sterile technique |
| Stump leak | 1-2% | Peritonitis, abscess | Antibiotics, drainage | Proper ligation technique |
| Port site hernia | 1-3% | Bowel obstruction, bulge | Hernia repair | Fascial closure for 10mm ports |
Clinical Pearls
Always explore all quadrants systematically.
Use open technique for first port insertion.
Use energy device for mesoappendix division.
Place ligature at base of appendix.
Leave 2-3mm stump to prevent leak.
Close fascia for 10mm ports.
Monitor for complications post-operatively.