Narrated Dipes appy
Timestops (6)
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Topic Overview
Key Takeaways
- Modified single-site appendectomy uses two umbilical ports (2.5mm or 2mm+4mm) plus one 3mm suprapubic port for near-scarless cosmesis.
- 90-degree retraction via suprapubic Babcock allows excellent cecal exposure; dual umbilical ports minimize instrument conflict with camera.
- Mesenteric division near appendiceal base with hook cautery minimizes excess cauterization and procedure time (typically ~10 minutes).
- 5mm stapler requires full 10-second compression before firing to ensure adequate tissue penetration and secure appendiceal stump seal.
- Specimen extraction via connected umbilical trocar sites yields nearly invisible scars at 2 weeks postoperatively.
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Transcript
This video represents a modification of a single site appendectomy which allows for a 90 degree retraction. Two umbilical ports, either 2 5s or a 2 and a 4, are placed through a 10 millimeter incision. A single 3 millimeter port is placed in the suprapubic area below the bikini line. This small incision results in an almost scarless defect. With a Babcock inserted through the lower port, the cecum is easily retracted to expose the appendix. A 5 millimeter Maryland can be used through the umbilical port next to the camera without significant dualling because of the two ports. In this case, a 4 millimeter 30 degree lens is used for the procedure, and you can see that the Maryland has. Almost complete range of motion without conflict with the scope. 5 millimeter hook is then used to take the appendiceal mesentery. And this is generally adequate uh in almost all cases. The mesentery is addressed near the base of the appendix to prevent. Uh. Excess cauterization. Uh, and re-cauterizing the appendiceal, uh, artery numerous times. This maneuver is relatively quick, uh, and this video is relatively unedited. Uh, the procedure took just 10 minutes. Here you can see the final attachments near the base of the appendix being taken, and again, uh this is a relatively safe maneuver with the hook cautery. Once this is. Completely taken down, the base of the appendix is compressed to ensure that there is no fecolith, uh, at the base of the appendix and that the tissue is adequately compressible to allow for use of the 5 millimeter stapler. The 5 millimeter stapler is then inserted through the low profile 5 millimeter port. And the base of the appendix is sealed and divided. It is important in cases like this to apply the stapler, allow the stapler to compress for a full 10 seconds prior to firing. This allows the 2 millimeter staplers to adequately, uh, get through the tissue and provide a safe seal. Here you can see the uh. Fired staple. And the secure staple line. A 5 millimeter endoscopic specimen bag is then placed through the 5 millimeter trochar site. Unfortunately, this bag does not fit through a true 5 millimeter port. With the appendix in the bag. And the bag is enclosed. And brought out through the umbilical trochar site period. The 5 and 4 millimeter trocars are then removed and the two sites connected to remove the specimen. Here you see the scars at 2 weeks postoperatively, and it is almost scarless.