16. laparascopic appendectomy 1.pptx

appendectomy

1. LAPAROSCOPIC APPENDECTOMY Facilitator: Dr. Hibaaq Mohamoud Resident-G/Surgery Moderator: Dr. Ringo (MD,MMED,MSC) 08/05/2022 Dr Hibaaq-laparascopic appendectomy

2. Session Objective We expect at the end; each participant will be able To describe the steps of laparoscopic appendicectomy 08/05/2022 Dr Hibaaq-laparascopic appendectomy

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4. The position of the patient The patient is placed in the supine position, combined with; Trendelenburg position Left lateral position (10–15 , inclined towards the surgeon) Right arm extended for intravenous and blood pressure cuff access by the anesthesiologist Left arm with the pulse oximeter is tucked in at the patient’s side 08/05/2022 Dr Hibaaq-laparascopic appendectomy

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6. Set up for lap appendectomy 08/05/2022 Dr Hibaaq-laparascopic appendectomy

7. Ready for lap appendectomy 5/8/2022 Dr.Rama-Laparoscopic appendectomy 7

8. Laparoscopic appendectomy cont… Operative preparation Urethral catheterization: to decompress the bladder to avoid injury while inserting the suprapubic ports. NGT The abdomen is prepped and draped in the routine manner. 08/05/2022 Dr Hibaaq-laparascopic appendectomy

9. Position of trocars and instruments Pneumoperitoneum: Established through the umbilicus with Veress needle or Hasson cannula or trocar. The videoscope is attached to the telescopic instrument The system white-balance and the focus adjusted 08/05/2022 Dr Hibaaq-laparascopic appendectomy

10. Laparoscopic appendectomy cont… Operating instruments: The operation is performed with four (4) permanent instruments: Grasping forceps Hook Scissors Needle holders with a single needled 2-0 cotton thread 08/05/2022 Dr Hibaaq-laparascopic appendectomy

11. Laparoscopic appendectomy cont… The patient in Trendelenburg position. Right side of the operating table may be elevated to hold the small bowel away from the right lower quadrant. Inspect the abdominal cavity thoroughly 08/05/2022 Dr Hibaaq-laparascopic appendectomy

12. Laparoscopic appendectomy cont… If the surgeon cannot obtain complete visualization of the appendix, mesoappendix, and base of the cecum for a safe transection, the operation is converted to an open procedure 08/05/2022 Dr Hibaaq-laparascopic appendectomy

13. Laparoscopic appendectomy cont… The surgical technique consists of doing the following steps: Exposure of appendix Control of mesentery Division of appendix base Extraction of specimen Suction and irrigation 08/05/2022 Dr Hibaaq-laparascopic appendectomy

14. Step 1 Hold the ileocecal appendix with grasping forceps introduced through right iliac fossa 5mm port. 08/05/2022 Dr Hibaaq-laparascopic appendectomy

15. Visualization and upward retraction of appendix 08/05/2022 Dr Hibaaq-laparascopic appendectomy

16. Laparoscopic appendectomy cont… Step 2 A dissecting forceps placed through the left iliac port creates a window in the mesoappendix at the appendiceal base. Caution should be taken not to injure the appendiceal artery during this manoeuvre 08/05/2022 Dr Hibaaq-laparascopic appendectomy

17. Options for ligation of mesoappendix Clips Endoloop ligatures Linear intestinal staplers 08/05/2022 Dr Hibaaq-laparascopic appendectomy

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19. Laparoscopic appendectomy cont… Step 3 Suture the base of the appendix with the cotton thread (needled 2-0 with 20 cm long) Two ligatures are placed 5 mm apart, close to the caecum Leave the two sutures on the caecum end. 08/05/2022 Dr Hibaaq-laparascopic appendectomy

20. Laparoscopic appendectomy cont… Step 4 Removal of the apprehended appendix, pulling the grasping forceps immediately after section into the trocar 08/05/2022 Dr Hibaaq-laparascopic appendectomy

21. Laparoscopic appendectomy cont… Alternatively: Sterile specimen retrieval bag is placed into the abdomen through a 12 mm suprapubic trocar and the appendix placed inside. 08/05/2022 Dr Hibaaq-laparascopic appendectomy

22. View of completed appendectomy after removal of the specimen 08/05/2022 Dr Hibaaq-laparascopic appendectomy

23. Laparoscopic appendectomy cont… Step 5 Suction and irrigation 08/05/2022 Dr Hibaaq-laparascopic appendectomy

24. Abdominal closure The abdomen is decompressed. The trocars removed. Routinely, only the 10-mm port sites require fascial closure. The skin is approximated with fine absorbable sutures. Adhesive skin strips and dry sterile dressings (Band-Aid bandages) are applied. 08/05/2022 Dr Hibaaq-laparascopic appendectomy

25. Postoperative care The OGT or NGT is removed before the patient awakens from anesthesia. The Foley catheter is discontinued as soon as the patient is alert enough to void. Postoperative pain can be controlled with oral medications. 08/05/2022 Dr Hibaaq-laparascopic appendectomy

26. Postoperative care cont….. Most patients can be weaned from intravenous fluid to simple oral intake within a day. Most patients are discharged home within a day or two. 08/05/2022 Dr Hibaaq-laparascopic appendectomy

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