【Laparoscopy】 Laparoscopic appendectomy
Appendicitis is a common surgical disease in daily life. The incidence is very high. If it is an ordinary appendix, it can be treated conservatively, but if it is acute purulent appendicitis or perforated appendicitis, the appendix should be removed in time. Laparoscopic appendectomy is a safe and feasible surgical method. Laparoscopy can improve the diagnosis rate of acute abdomen in the right lower abdomen, and the scope of intraoperative examination is wider. The surgeon can better observe the pelvic cavity, large and small intestine and most of the abdominal internal organs.
Indications of laparoscopic appendectomy:
(1) Appendicitis in the elderly and children;
(2) Obesity;
(3) Acute suppurative appendicitis, gangrenous perforated appendicitis and peritonitis;
(4) Abdominal surgical diseases and female internal reproductive system diseases cannot be completely excluded. However, in the following situations, laparotomy must be performed in time: (1) The appendix root is necrotic and perforated, and the appendix stump cannot be reliably treated; (2) The appendix is severely adhered to the adjacent intestine or other organs, and the anatomical relationship is unclear; (3) The appendix It is extraperitoneal or ectopic in the wall of the cecum, which is difficult to dissect; (4) malignant tumor of the appendix; (5) serious side injury occurred, such as damage to the adjacent intestinal tube.
Contraindications of laparoscopic appendectomy:
(1) Those who have a history of abdominal surgery or have other diseases that may cause severe adhesions in the abdominal cavity;
(2) Those who are accompanied by diseases of important organs such as the heart and cannot tolerate general anesthesia;
(3) Diaphragmatic hernia patients;
(4) Those with coagulation dysfunction;
(5) Pregnant women over 6 months;
(6) Abscesses around appendix, appendix masses, acute appendicitis combined with severe peritonitis and severe systemic infection;
(7) Other situations not suitable for laparoscopic surgery or appendectomy.
Equipment requirements for laparoscopic appendectomy:
(1) Laparoscopy at 0° or 30°;
(2) Medical cold light source;
(3) Endoscope camera;
(4) Insufflator;
(5) HD medical monitor；
(6) Laparoscopy equipment package (insufflation needle, monopolar or bipolar coagulator, puncture cannula, scissors, laparoscopic separation forceps, non-traumatic grasping forceps, titanium clamps, knotter, converter, irrigator , Monopolar line, ultrasonic knife, etc.)
Surgical technique:
(1) Build the pneumoperitoneum pressure to 10 ~ 14mmHg. Poke a hole at the umbilical hole, insert a cannula, put in a laparoscope, and explore the abdominal cavity. If the patient has a history of abdominal surgery and considers abdominal adhesions, an open method is used to establish a pneumoperitoneum, and the cannula is placed under direct vision and then inflated to establish a pneumoperitoneum. Insert 5mm cannula into the left lower abdomen and right lower abdomen, and insert instruments to help expose and explore;
(2) Laparoscopic exploration. Carefully check the ileocecal area, pelvis, large and small intestine and other parts of the abdominal cavity to rule out other acute abdomen in the abdominal cavity. Find the appendix along the three colonic bands of the cecum to clarify the inflammation and scope of the appendix;
(3) Treatment of appendix mesangium and root. Use non-invasive grasping forceps or Babcock forceps to clamp the head of the appendix and the mesangium, lift it up, and separate the mesangium to the root of the appendix with a separating forceps electrocautery, ultrasonic knife or ligation clamp. Double ligation of the root with a snare, or ligature clip or endoscopic suture technique, or use Endo-GIA to cut and close the root together with the mesangium, cut off the appendix, and cauterize the mucosa of the appendix stump with electrocoagulation;
(4) The appendix is taken out. The method of removing the appendix is very important. If the appendix is small, it can be removed through a 10mm cannula. If the appendix is large or gangrene or perforation has occurred, the appendix should be taken out in a specimen bag. In principle, avoid contact between appendix and abdominal incision to prevent incision infection;
(5) Flush the surgical field with normal saline, check the appendix stump again, release the pneumoperitoneum after confirming that there is no bleeding, close the incision, if the appendix is perforated or the local inflammation is severe, and there is more exudation, drainage can be placed.
Advantages of laparoscopic appendectomy:
(1) The trauma is small, the pain is light, and there is generally no need to inject analgesics;
(2) The intestinal function recovers quickly after the operation and the hospital stay is short;
(3) The surgical field is clearly exposed, the diagnostic accuracy is high, and the abdominal and pelvic cavity can be fully explored. It can provide a more reliable diagnosis method for patients with undiagnosed right lower abdominal pain, especially young female patients;
(4) The incidence of postoperative complications is low, and the incidence of incision infection, intestinal adhesions, and abdominal abscess are lower than that of traditional surgery;
(5) The scar of abdominal wall incision is smaller, which is more in line with the needs of cosmetics.
