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Lap Appendectomy

APPENDECTOMY PROCEDURE MODULE

The most comprehensive, structured curriculum and hands-on training for laparoscopic appendectomy.

Not only is the Appendectomy Module on the LAP Mentor the most sophisticated training resource for this procedure, there is such a life-like realism to the graphics that the visuals could easily be mistaken for those taken in live surgery. This simulation includes components such as high fidelity tissue response to dissection, realistic bleeding and inflammation.

INTRODUCTION:

Appendectomy is the most common operation in emergency situations. Although dating more than 30 years after the first laparoscopic appendectomy, it is still performed by laparotomy in more than 90% of cases in our country. Several causes determine this high index of laparotomic procedures and, among them, it can be mentioned the cost of equipment and used inputs.

TECHNIQUE:

  • Three incisions for trocars are performed. The first, 5 to 10 mm in length, is made in the umbilicus for the optical device (incision is dependent on optical diameter) using permanent metallic trocar.
  • Two other suprapubic incisions are performed at low bilateral position, medial to the epigastric vessels. On the right side is introduced one 5 mm permanent metallic trocar; on the left, another of 10 mm with reducer to 5 mm.
  • The surgeon is on the left side of the patient, with the first assistant on his right and instrumentation table on the left. The monitor is put on the right side of the patient.
  • The operation is performed with four permanent instruments: grasping forceps, hook, scissors and needle holders. A single needled 2-0 cotton thread is used.


  • The surgical technique consists on doing the following steps: 1) hold the ileocecal appendix with grasping forceps introduced through right iliac fossa; 2) with the hook in the left iliac fossa trocar, isolate the appendix from its meso since its edge going gradually to the base, including the epiploic appendices near the appendix and cecum, releasing them from the vicinity suture the base of the appendix with the cotton thread (needled 2-0 with 20 cm long).
  • suture the base of the appendix with the cotton thread (needled 2-0 with 20 cm long), transfixing the serous with two sutures for better fixation, with optional one more distal suture between the sutures, without risk of extravasation of its content; 4)
  • cut the suture thread at the appendix base and the remainder needled thread remains in the abdominal cavity to be used in appendiceal stump invagination; 5)


  • hold appendix near the base using grasping forceps introduced through 10 mm reducer trocar in the left iliac fossa, or between the two sutures, when the second suture was performed; 6) section of the appendix using the hook introduced through the right iliac fossa;
  • the suture between the base and the graspingforceps (or between the two suture), avoids leakage of the contents of the appendix removal of the apprehended appendix , pulling the grasping forceps immediately after section into the trocar;normally the diameter of the appendix allows its removal pulling up with the reducer and, without the meso, even thicker inflammatory appendix can be pulled out through the 10 mm trocar; 8) put the appendix within the 10 mm trocar; 9)
  • the 10 mm trocar is withdrawn from the abdominal wall with the appendix inside and, afterward is introduced again; this maneuver avoids the use of extraction bags which, besides increasing the cost of the procedure, requires movements to put the appendix inside which may require time and risk of contamination of the abdominal cavity; 10) made an oversuture on the cecum around the appendiceal stump doing its invagination.