Two Laparoscopic Appendectomy Techniques in Benign Gynecologic Surgery

Abstract

<h3>Study Objective</h3> To demonstrate two laparoscopic appendectomy techniques used during gynecologic surgery for benign indications. <h3>Design</h3> Not applicable. <h3>Setting</h3> In both videos, patients were placed in the standard dorsal lithotomy position with moderate Trendelenburg tilt throughout the duration of the surgery. <h3>Patients or Participants</h3> Patients in both videos presented with chronic pelvic pain thought to be secondary to endometriosis. Their symptoms were refractory to medical management. After appropriate counseling, patients opted for diagnostic laparoscopy with possible endometriosis excision. Both patients were counseled on the risks and benefits of concurrent appendectomy at the time of surgery, and both have given their written consent. <h3>Interventions</h3> With the first technique, an ENDOLOOP ligature was used to double ligate the base of the appendix followed by excision using the laparoscopic scissors. The specimen was removed by using an Endo Catch specimen retrieval device. With the second technique, a 35 mm vascular stapler was used to seal and transect the appendix at the base. The specimen was removed directly from laparoscopic port. <h3>Measurements and Main Results</h3> We demonstrated two techniques for laparoscopic appendectomy. Both patients tolerated the procedures well, and their postoperative recovery was uneventful. The patient who underwent appendectomy with the stapler, pathology revealed evidence of acute appendicitis. <h3>Conclusion</h3> Appendiceal endometriosis is observed in 2.6% of patient who underwent surgery for endometriosis. ENDOLOOP ligature and vascular stapler are both well tolerated and effective method used in laparoscopic appendectomy. Gynecologists should attempt to incorporate routine assessment of the appendix during benign gynecologic surgeries and be able to perform concurrent appendectomy should the need arise.