Informed consent was obtained. Preoperative antibiotics were provided. The patient was brought into the operating room and positioned supine upon the operating table. General anesthesia was induced, and the patient was intubated without complications. The left arm was tucked. The patient's abdomen was prepped with chlorhexidine and draped in standard sterile fashion. A timeout was performed, correctly identifying patient, procedure, site and side of surgery. All were in agreement.
Access to the peritoneal cavity was gained safely through an incision in the left upper quadrant using the Optiview technique. The abdomen was examined which demonstrated no injury to the bowel. Pneumoperitoneum was achieved. A 12 cm port was placed in the left lower quadrant under direct visualization. A 5 mm suprapubic port was also placed. We then placed the patient in Trendelenburg with right side up.
The appendix was located in [ ] and noted to be [ ]. A window was created with blunt dissection between the appendix and mesoappendix. The base of the appendix was transected with an Ethicon 45mm blue load Echelon Flex powered laparoscopic stapler. The mesoappendix was dissected using a Harmonic scalpel. The abdomen was examined thoroughly was deemed hemostatic. The 12mm port was extended to accommodate the large appendix. The appendix was removed in an EndoCatch bag. The abdomen was desufflated. A fascial closure was performed at the LLQ port site using an 0-Vicryl running stitch. Skin for all three incisions was approximated using 4-0 Monocryl and dressed with Dermabond.
Instrument and sponge counts were correct at the end of the procedure. The patient was extubated in the OR and transferred to the PACU in stable condition. The attending surgeon was present and scrubbed during the entire procedure.
Service: GS (white)
Author: Garrett Skinner