Laparoscopic Appendectomy: Surgical Techniques for the Benign Gynecologist

Abstract

<h3>Study Objective</h3> To demonstrate two methods of performing a laparoscopic appendectomy in the setting of endometriosis. <h3>Design</h3> Stepwise demonstration of advanced laparoscopic techniques with narrated video footage. <h3>Setting</h3> Laparoscopic appendectomies may be performed incidentally at the time of a gynecologic procedure or for treatment purposes. In our practice, we typically perform appendectomies in the setting of endometriosis, where appendiceal endometriosis rates may range from 10-40%, especially in the presence of deep infiltrating endometriosis or ovarian endometriomas. In these cases, an appendectomy may be warranted to perform a complete resection of endometriosis and may be diagnostic or therapeutic in patients with chronic pelvic pain. <h3>Patients or Participants</h3> Patients undergoing laparoscopic excision of endometriosis requiring a concurrent appendectomy. <h3>Interventions</h3> Although uncommonly performed by gynecologists, appendectomies may be performed for complete disease management of endometriosis or prevention of future appendicitis. Sound surgical technique and knowledge of the anatomy will allow most laparoscopists to safely perform this procedure. Several key strategies include: 1. Identification of the appendix and its surrounding landmarks. 2. Division of the mesoappendix in order to ligate the appendiceal artery and to skeletonize the appendix. 3. Transection of the appendix with either Endoloops or the endoscopic gastrointestinal stapler. 4. Containment of the appendix within a specimen retrieval bag to avoid contamination. <h3>Measurements and Main Results</h3> This video provides a narrated stepwise demonstration displaying two methods of how to perform a laparoscopic appendectomy featuring the Endoloop and the endoscopic gastrointestinal stapler. <h3>Conclusion</h3> Laparoscopic appendectomies can be performed successfully by benign gynecologists and are particularly useful in the complete management of endometriosis. Here we demonstrate two common methods for performing a laparoscopic appendectomy, highlight relevant surgical anatomy, and provide key surgical strategies for the safe completion of this procedure.