- Two 5mm, one 12mm disposable trocars
- One 5mm fenestrated grasping forceps
- 5mm Maryland forceps
- Endoloops x 2
- Retrieval bag
- Suction irrigation
- 14Fr suction drain
Bristol Laparoscopic Associates use two 5mm suprapubic (R & L) operating ports (the left can be replaced with 10/12mm for appendix extraction) and 12mm umbilical port.
we always use a 30 degree scope. Use the right hand port (surgeons left hand) to manipulate the appendix. Use the left hand port for the operative dissection etc.
We use Maryland forceps with monopolar diathermy to divide the appendix mesentery and coagulate the appendicular artery.
Inflammatory adhesions can be divided using 5mm forceps. In severe inflammation/appendix mass/abscess use suction irrigation. If things are hard and fibrotic use a harmonic scalpel.
In cases where the appendix stump is at risk we would suggest that you use an endostapler and remove an additional cuff of caecum.
Alternatively use two endo loops. The first to close off the appendix base. The second a little way up the appendix.
Leave the endo-loop attached to the appendix to facilitate retrieval by pulling appendix into a 10 mm port.
Alternatively, emove the appendix through the umbilicus. If a 5mm laparoscope is available, remove through the umbilicus using a retrieval bag.
Remove thickened mesoappendix/appendix through an enlarged umbilical incision.
Leave a pelvic suction drain for 24 hrs in severe inflammation.
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