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A surgical procedure in which the appendix is removed from right lower abdominal wall, while surgical team watches an enlarged image of the patients internal organs on a television monitor. This procedure is preformed by a general surgeon. The appendix is removed when an infection has made it inflamed and swollen resulting in appendicitis. The infection may occur when the opening of the appendix becomes clogged with bacteria and stool.
The patient is placed in supine position on the operating table, abdomen is disinfected and surgical drapes are applied over the patient. the OR team will identify patient by ID bracelet, The team will also confirm which part of the body they will be operating on as a safety check before they begin surgery. A phemuo-peritoneum is created in the usual fashion. The trocars are inserted. An atraumatic grasper (endo babcock) or (dolphin nose grasper) is inserted via the right upper quadrant trocar. The cecum is retracted upward toward the liver. In most cases this maneuver will elevate the appendix in the optical field of the telescope. The appendix is grasped with a 5 mm supra-pubic trocar. It is held toward the abdominal wall. A dolphin nose grasper is used to create a mesenteric window under the base of the appendix. The window is made as close as possible to the base of the appendix, and should be approximately 1 cm in size. The appendix is transected by inserting a multi-fire endogia 30 instrument closing it around the base of the appendix and firing it. The base of the appendix is inspected for Hemostasis. The operator should wait a few minutes before initiating any measures to stop any bleeding site on the staple line, as it will most likely stop spontaneously.
The multi-fire 30 cartridges is changed to a vascular cartridge (white 2.5) and the meso-appendix is transected with the same instrument. Several cartridges may have to be used. The appendix is now amputated from the gastro intestinal tract. A 10 mm endocatch instrument is inserted via the ruq trocar, and deployed in the abdominal cavity. The appendix held by the grasper (via the supra-pubic trocar), is placed into the specimen bag. The bag is closed and the endocatch instrument is removed with the trocar from the abdominal cavity. The endocatch instrument is separated from the trocar, and the trocar is reinserted. The intra-abdominal cavity is irrigated thoroughly with normal saline. For perforated appendicitis with or without an intra-abdominal abscess, A blake drain is left in the right lower quadrant and pelvis. The wound is now closed and sutured up, and sterile dry dressing is applied over wound. the patient is brought into recovery area while nurses will monitor patient for a few hours and vitals will be checked often to ensure its safe before patient is sent home.
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