UNIVERSITY TECHNICAL OF MACHALA

APPENDECTOMY
MEMBERS:

ROBERTO MANSILLA
CARLA URGILES
CRISTIAN ALVARADO
TEACHER :
ING.MARIBEL BARRETO

SEMESTRE:
EIGTH SEMESTER B

PERIOD:
OCTUBER 2016 FEBRAURY 2017. DATE : 13 OF DECEMBER /2017
UNIVERSITY TECHNICAL OF MACHALA

LAPAROSCOPIC
APENDICECTOMY
Surgical Technique
 UNIVERSITY TECHNICAL OF MACHALA

Anatomy
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Anatomical Variants

Pelvis
Subhepatic
Blind retrovert
 UNIVERSITY TECHNICAL OF MACHALA

Advantages of laparoscopic approach

If there are diagnostic doubts, best method
Lower rate of wall infections, especially in obese, ap.
Ectopic and peritonitis
Best cosmetic result
The same rate of postoperative intra-abdominal
abscesses
 UNIVERSITY TECHNICAL OF MACHALA

POSITION OF PATIENTS
Supine decubitus
Right arm in right angle Left arm along the
body
Variant: gynecological position (diagnostic
doubts)
Surgeon and assistant to the left of the
patient
 UNIVERSITY TECHNICAL OF MACHALA
TROCKS
Three trocks (1 optic y 2 for work)
Trocks for optic:
10 mm (5 mm in children )
Supraumbilical (o sub o ltero)
Trocks for Works (5/10 mm)
FII y Suprapbico
2 en FII
FII y FID
2 suprapbicos 8(cosmetics reasons)
Adittional retractors in HD (obeses..)
 UNIVERSITY TECHNICAL OF MACHALA
PRECAUTION
Trocks
Periumbilical Zone : aorta, cava inferior, ilacs vessels
Epigastrium: epigstric arteries
Suprapbic region: bladder and umbilical arteries
 UNIVERSITY TECHNICAL OF MACHALA

Vascularization
A Mesentrica
superior

Art ileoclica
A cecal ant
A cecal post
A apendicular
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INSTRUMENTAL
Optic of 0
Atraumatic traction clamp
System of irrigation-aspiration
Monopolar Hook
Scisors
Loops
Extraction Bag
Others: Endoclips, bipolar, stapler, porta y suture....
 UNIVERSITY TECHNICAL OF MACHALA

LAPAROSCOPIC TECHNIQUES
OPEN CLOSE
Externalize appendix by With 3 trokars
umbilical trocar Detailed Below
Mesoappendix intact
Once out, technique identical
to laparotomy
 UNIVERSITY TECHNICAL OF MACHALA

TECHNIQUE
Umbilical trokar by minilaparotomy or after Veress
1.- Review of:
Colon dcho
Ileon terminal
Female Genitals
Intraabdominales Collections
 UNIVERSITY TECHNICAL OF MACHALA

TECHNIQUE
2.- Exposure of the appendix and mesoappendix by atraumatic clamp.
3.-In cases of plastron, take off epiplon and attached ileal loops.
4.- Visualization and section of mesoappendix vessels with hook
(bleeding is controlled with bipolar).
 UNIVERSITY TECHNICAL OF MACHALA

TECHNIQUE
2.- Exposure of the appendix and mesoappendix by atraumatic
clamp.
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5.- Ligature of the appendicular base

Several (2-3)
loops of
resorbable
slow suture.
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LIGATURE OF THE BASE

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TECHNIQUE
5.- Ligation of the appendicular base with several (2-3) loops of slow
reabsorbable suture.
A clip can be applied (previous expression).
Preferably stapler if very inflamed
6.- Section of the appendix between ligatures.
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6.- Section of the appendix between

ligatures.
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TECHNIQUE
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TECHNIQUE
7.- Exteriorization of the appendix
Bag
Setting of two trocars
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TECHNIQUE
8.- Obacco bag (optional)
9.-Thorough washing of peritoneal cavity,
mainly
* Douglas sack background
* Right parieto-colic space
* Subhepatic region
 UNIVERSITY TECHNICAL OF MACHALA

TECHNIQUE

10.- Peritoneal cavity revision

11.- Close by planes of the entrance doors
UNIVERSITY TECHNICAL OF MACHALA

THANK YOU