A case of complicated appendicitis is presented to illustrate a safe laparoscopic appendectomy technique. What makes extirpation so difficult in complicated appendicitis? Infection and tissue injury initiate the release of cytokines, which attract the omentum and cause contiguous loops of bowel to adhere, effectively isolating the inflammatory locus. Surgical dissection must reverse this process. Visualization is excellent in laparoscopy; however, operators lack tactile sensation; and when organs are fused together, touch is a valuable aid to accurate dissection. Injury to the adjacent organs (small bowel, colon, fallopian tubes, or ureter) may occur and require repair or resection (cecectomy or hemicolectomy). What is needed is an operative technique that is safe and effective in these challenging situations, especially when the appendix is adherent to adjacent structures and encased in a cocoon of (highly vascularized) fibrous tissue, a phlegmon. The technique presented is derived from open surgery. It is utilized to avoid injuring vulnerable structures in the pelvis, when performing a proctectomy for ulcerative colitis or Hirschsprung’s Disease. This goal is accomplished by maintaining a plane of dissection that abuts the rectal wall. The same technique is applied in complicated appendicitis to avoid injuring adjacent organs. This procedure is contrasted with an alternate (simpler) technique applicable to uncomplicated appendicitis.