Simple technique for laparoscopic appendicectomy to ensure safe division of the mesoappendix

Abstract

Different instruments, such as endoscopic stapler, endoscopic clip, monopolar hook cautery, harmonic scalpel, and vessel sealing instrument, have been described in appendiceal mesentery dissection (1). Cutting the appendiceal mesentery by laparoscopic scissors and suturing take more time and require intracorporeal experience to tie a knot. On the other hand, endoscopic stapler is expensive. Classical bipolar electrosurgical systems and ultrasonic thermal energy are inadequate for the hemostasis of vessels >2 mm in diameter (2). Several shortcomings are associated with the use of conventional monopolar diathermy, such as thermal injury risk, difficulty in hemostasis, smoke production, and the need of use of additional tools, such as bipolar graspers, sutures and clips. Sharp dissection has the advantage of high heat production with thermal spread in surrounding structures and charring. It has some risks of direct coupling to another metal instrument, direct sparking, and the passage of current from recently coagulated, electrically isolated tissue (3). A simple cost-effective technique is described in this article to provide safe division of the mesoappendix that avoids the use of diathermy with its potential hazards. The technique utilizes a small number of clips. It is particularly useful in cases where the cecum is mobile, as it saves the need for an additional port to achieve control at the base of the appendix. TECHNIQUE