Page 5 - WJOLS - Laparoscopic Journal

WJOLS

Technical Modifications in Laparoscopic Appendectomy
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In comparison, the visibility of a periumbilical telescope is exposure for laparoscopic appendectomy. However, there
less desirable as it might be impaired by a distended cecum. are some important technical points during trocar insertion
Second, with the tip of appendix retracted upward by the in the suprapubic region. Selection of suitable position with
left hand grasper, the mesoappendix would assume a careful transillumination is necessary to prevent bleeding
favorable position for dissection by a dissector inserted from abdominal wall vessels. Insertion of trocars in this
through the periumbilical port (see Fig. 2). Third, an place can be slightly difficult because the suprapubic
instrument in this position carries less risk of peritoneum is flexible and typically results in tenting of the
electrocoagulation injury to the sigmoid loop compared to peritoneum before the trocar tip penetrates into the abdominal
when it is inserted through the left lower quadrant port. cavity (Figs 5A and B). Routine use of Foley catheter
Therefore, this configuration provides good and safe surgical prevents urinary bladder injury. 3

A D

B E

C F
Figs 4A to F: Closure of the mesoappendix (A-C) and base of appendix (D-F) with one hem-o-lok clip on
patient side and one on specimen side

World Journal of Laparoscopic Surgery, January-April 2011;4(1):1-4 3