Laparoscopic Appendectomy with Harmonic

Details of Procedure

DVT prophylaxis has been ordered within 24hrs of surgery

Second generation cephalosporin / therapeutic antibiotics were started prior to incision.

The patient was correctly identified, transferred to the operative room. General anesthesia was administered. After his abdomen was prepped and draped in a sterile fashion, a mid-line supraumbilical incision was made and an open Hassan procedure used to place a 12mm trochar. The abdomen was insuflated to 15mmHg. I then placed a 5mm suprapubic port followed by a 5mm left lower quadrant port.

The appendix was visualized in the right lower quadrant. The appendix was grasped and the base of the appendix appeared healthy. I then transected the mesoappendix from the appendix using the harmonic. This dissection extended to include the appendiceal artery. The appendix was then ligated with a PDS endoloop at the base and a second endoloop more distal. I then used the harmonic to transect the appendix between the endoloops. Hemostasis was obtained. The appendix was placed in an endocatch bag.

The abdomen was irrigated with copious saline. The appendix was removed through the umbilicus in the endocatch bag. The abdomen was desuflated and umbilical fascia closed with 0-vicryl. All skin incisions were irrigated and closed with 4-0 monocryl. Local anesthesia and Dermabond were applied.

Lap Appy Preferences:

• Equipment:

  • 30 degree scope

  • Balloon Hassan trocar

  • two 5mm trocars

  • 11 blade

  • suction irrigator

  • laparoscopic graspers

  • laparoscopic maryland

  • harmonic

  • 0 vicryl on UR-6

  • 4-0 monocryl

  • 2% Lidocaine with epinephrine

  • endocatch bag

  • dermabond for dressing

  • Available (do not open yet):

    • 45mm GIA with blue loads

    • two PDS endoloops

• Patient:

  • foley unless just urinated (ask MD)

  • left arm tucked