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Laparoscopic appendectomy and fenestration of hemorrhagic ovarian cyst
This is the case of a 19-year-old female patient who was admitted to the emergency department for lower abdominal pain going on for 24 hours. No abdominal guarding was noted. Biological findings showed an inflammation with leukocytes at 16,000 and CRP levels at 112. CT-scan showed the presence of an enlarged appendix (9mm thick) along with a voluminous adnexal cyst, which may be suggestive of a tubo-ovarian abscess. Laparoscopic exploration is performed. Congestive appendicitis is confirmed, as well as the presence of a hemorrhagic right ovarian cyst. Laparoscopic appendectomy is performed and the hemorrhagic ovarian cyst is fenestrated.
M Ignat, D Mutter, J Marescaux
Surgical intervention
1 year ago
3942 views
410 likes
0 comments
04:57
Laparoscopic appendectomy and fenestration of hemorrhagic ovarian cyst
This is the case of a 19-year-old female patient who was admitted to the emergency department for lower abdominal pain going on for 24 hours. No abdominal guarding was noted. Biological findings showed an inflammation with leukocytes at 16,000 and CRP levels at 112. CT-scan showed the presence of an enlarged appendix (9mm thick) along with a voluminous adnexal cyst, which may be suggestive of a tubo-ovarian abscess. Laparoscopic exploration is performed. Congestive appendicitis is confirmed, as well as the presence of a hemorrhagic right ovarian cyst. Laparoscopic appendectomy is performed and the hemorrhagic ovarian cyst is fenestrated.
Laparoscopic appendectomy for recurrent appendicitis after medical treatment
Appendectomy is the only curative treatment of appendicitis. However, the management of patients with an appendiceal mass or abscess can be temporarily managed medically with intravenous antibiotic therapy and/or percutaneous drainage. And yet, there are many controversies over the non-operative management of acute appendicitis. In 2015, Fair et al. used data from the American College of Surgeons National Surgical Quality Improvement Project to evaluate 30-day morbidity and mortality of intervention (laparoscopic and open appendectomy) at different time periods. A delay of operative intervention longer than 48 hours was associated with a doubling of complication rates. Elective appendectomy can be performed after 6 to 8 weeks later, which proves successful in the vast majority of patients.
This is the case of an 83-year-old man who presented with an acute appendicitis treated medically in another hospital. The patient had a past medical history of arterial hypertension, cardiomyopathy, previous cerebral ischemia, and rectal polyp. A delayed appendectomy was planned. However, before the procedure, a total colonoscopy was performed because of the history of polyps. This elderly patient was hospitalized for colonoscopy. At admission, he presented with fever, right iliac fossa tenderness, and a biological inflammatory syndrome. A CT-scan was performed. It showed a recurrent acute appendicitis without mass, with a 2cm abscess on the tip of the appendix. An appendectomy was performed in this case.
A D'Urso, D Mutter, J Marescaux
Surgical intervention
1 year ago
4366 views
340 likes
0 comments
05:00
Laparoscopic appendectomy for recurrent appendicitis after medical treatment
Appendectomy is the only curative treatment of appendicitis. However, the management of patients with an appendiceal mass or abscess can be temporarily managed medically with intravenous antibiotic therapy and/or percutaneous drainage. And yet, there are many controversies over the non-operative management of acute appendicitis. In 2015, Fair et al. used data from the American College of Surgeons National Surgical Quality Improvement Project to evaluate 30-day morbidity and mortality of intervention (laparoscopic and open appendectomy) at different time periods. A delay of operative intervention longer than 48 hours was associated with a doubling of complication rates. Elective appendectomy can be performed after 6 to 8 weeks later, which proves successful in the vast majority of patients.
This is the case of an 83-year-old man who presented with an acute appendicitis treated medically in another hospital. The patient had a past medical history of arterial hypertension, cardiomyopathy, previous cerebral ischemia, and rectal polyp. A delayed appendectomy was planned. However, before the procedure, a total colonoscopy was performed because of the history of polyps. This elderly patient was hospitalized for colonoscopy. At admission, he presented with fever, right iliac fossa tenderness, and a biological inflammatory syndrome. A CT-scan was performed. It showed a recurrent acute appendicitis without mass, with a 2cm abscess on the tip of the appendix. An appendectomy was performed in this case.
Laparoscopic appendectomy after appendicular phlegmon
Appendicitis is one of the main reasons for consultation and surgical interventions in the emergency departments around the world. If it is not diagnosed and treated timely, it can evolve towards an appendicular perforation, and as a result, it can become a peritonitis or an appendicular phlegmon. This latter case may occur in approximately 10% of cases.
Currently, the management of the appendicular phlegmon is controversial. Some authors prefer to perform an appendectomy immediately, and others are in favor of medical treatment using antibiotic therapy and percutaneous drainage if possible and delay appendectomy.
In this case, we present a patient presenting with an appendicular phlegmon in which a conservative management with percutaneous drainage and delayed surgery were decided upon.
P Saleg, A D'Urso, D Mutter, J Marescaux
Surgical intervention
2 years ago
8725 views
518 likes
0 comments
04:17
Laparoscopic appendectomy after appendicular phlegmon
Appendicitis is one of the main reasons for consultation and surgical interventions in the emergency departments around the world. If it is not diagnosed and treated timely, it can evolve towards an appendicular perforation, and as a result, it can become a peritonitis or an appendicular phlegmon. This latter case may occur in approximately 10% of cases.
Currently, the management of the appendicular phlegmon is controversial. Some authors prefer to perform an appendectomy immediately, and others are in favor of medical treatment using antibiotic therapy and percutaneous drainage if possible and delay appendectomy.
In this case, we present a patient presenting with an appendicular phlegmon in which a conservative management with percutaneous drainage and delayed surgery were decided upon.
Low-cost laparoscopic appendectomy: how to teach
Laparoscopic appendectomy must be the gold standard. Nowadays, many centers still continue to go on with McBurney’s incisions. Why? Expensive devices may be a reason. Low cost appendectomy allows for a diagnostic laparoscopy and offers a therapeutic option with the lowest price.
On the other hand, residents must begin the learning curve in laparoscopy as soon as possible not only with a training center (training in cadaveric or animals) but they must also start practicing on humans with watchful surgeon/teacher’s eyes.
The aim of this video is to demonstrate that low-cost laparoscopic appendectomy is feasible not only for surgeons but also for residents operating with an expert.
S Rua, G Machado , P Mira
Surgical intervention
3 years ago
9874 views
562 likes
0 comments
08:49
Low-cost laparoscopic appendectomy: how to teach
Laparoscopic appendectomy must be the gold standard. Nowadays, many centers still continue to go on with McBurney’s incisions. Why? Expensive devices may be a reason. Low cost appendectomy allows for a diagnostic laparoscopy and offers a therapeutic option with the lowest price.
On the other hand, residents must begin the learning curve in laparoscopy as soon as possible not only with a training center (training in cadaveric or animals) but they must also start practicing on humans with watchful surgeon/teacher’s eyes.
The aim of this video is to demonstrate that low-cost laparoscopic appendectomy is feasible not only for surgeons but also for residents operating with an expert.
Monopolar laparoscopic appendectomy
The laparoscopic approach is the gold standard for acute appendicitis. There are several surgical devices to achieve hemostatic control of the appendicular artery (monopolar electrocautery, endoclip, endostapler, ultrasonic scalpel, and LigaSure™ vessel-sealing device), which vary widely according to the surgeon’s preference and availability in the institution. All devices are effective and safe, but monopolar electrocautery systems are the most cost-effective ones.
A 24-year-old woman was admitted to our emergency department with a 24-hour evolution of right iliac fossa pain. No other symptoms were noted. An abdominal ultrasound was suggestive of an acute appendicitis.
This full length surgical movie shows the feasibility and safety of monopolar electrocautery for meso-appendiceal dissection. The intra-abdominal procedure was achieved in 5 minutes 30 seconds.
No complications were observed and the patient was discharged home on the next postoperative day.
P Leão, A Goulart
Surgical intervention
4 years ago
9727 views
332 likes
0 comments
06:14
Monopolar laparoscopic appendectomy
The laparoscopic approach is the gold standard for acute appendicitis. There are several surgical devices to achieve hemostatic control of the appendicular artery (monopolar electrocautery, endoclip, endostapler, ultrasonic scalpel, and LigaSure™ vessel-sealing device), which vary widely according to the surgeon’s preference and availability in the institution. All devices are effective and safe, but monopolar electrocautery systems are the most cost-effective ones.
A 24-year-old woman was admitted to our emergency department with a 24-hour evolution of right iliac fossa pain. No other symptoms were noted. An abdominal ultrasound was suggestive of an acute appendicitis.
This full length surgical movie shows the feasibility and safety of monopolar electrocautery for meso-appendiceal dissection. The intra-abdominal procedure was achieved in 5 minutes 30 seconds.
No complications were observed and the patient was discharged home on the next postoperative day.
Laparoscopic interval appendectomy after conservative treatment of an appendiceal abscess
Appendectomy is the standard treatment for acute appendicitis in adults and children. However, more and more studies demonstrate that a conservative treatment with antibiotics and radiological drainage, if required, is effective and may be of importance in complicated cases and in older frail patients [1].
In the absence of randomized controlled trials, there is no consensus on whether an appendectomy at distance from the acute phase (interval appendectomy) is necessary for conservatively treated patients. A large observational study has shown that about 10% of these patients will require an appendectomy [2] over a period of several years. However, a histopathological study of appendices removed during interval appendectomy after conservative management of pediatric patients with acute appendicitis with an inflammatory mass or abscess concluded that more than half of the patients had strong histopathological changes in the appendix, thereby suggesting a high possibility of recurrence [3].
This is the case of a 58-year-old female patient presenting with a perforated appendix with an appendiceal abscess, treated by antibiotherapy and radiological drainage. She has a past history of uterine cancer treated by radiochemotherapy and total hysterectomy, complicated by bilateral ureteral stenoses after radiotherapy, treated by long-term pig-tail urinary catheters, as well as a postoperative abdominal hernia treated by means of an abdominal underlay mesh. Even though the initial non-surgical treatment of her complicated acute appendicitis was successful, an interval appendectomy was indicated because of persistent abdominal pain in the right lower quadrant (RLQ). The operation was performed laparoscopically with a simple postoperative course.
References:
1. Tannoury J. Abboud B. Treatment options of inflammatory appendiceal masses in adults. World J Gastroenterol 2013;19:3942-50.
2. McCutcheon BA, Chang DC, Marcus LP, Inui T, Noorbakhsh A, Schallhorn C, Parina R, Salazar FR, Talamini MA. Long-term outcomes of patients with nonsurgically managed uncomplicated appendicitis. J Am Coll Surg 2014;218:905-13.
3. Otake S, Suzuki N, Takahashi A, Toki F, Nishi A, Yamamoto H, Kuroiwa M, Kuwano H. Histological analysis of appendices removed during interval appendectomy after conservative management of pediatric patients with acute appendicitis with an inflammatory mass or abscess. Surg Today 2014;44:1400-5.
D Ntourakis, D Mutter, J Marescaux
Surgical intervention
4 years ago
5333 views
169 likes
0 comments
12:12
Laparoscopic interval appendectomy after conservative treatment of an appendiceal abscess
Appendectomy is the standard treatment for acute appendicitis in adults and children. However, more and more studies demonstrate that a conservative treatment with antibiotics and radiological drainage, if required, is effective and may be of importance in complicated cases and in older frail patients [1].
In the absence of randomized controlled trials, there is no consensus on whether an appendectomy at distance from the acute phase (interval appendectomy) is necessary for conservatively treated patients. A large observational study has shown that about 10% of these patients will require an appendectomy [2] over a period of several years. However, a histopathological study of appendices removed during interval appendectomy after conservative management of pediatric patients with acute appendicitis with an inflammatory mass or abscess concluded that more than half of the patients had strong histopathological changes in the appendix, thereby suggesting a high possibility of recurrence [3].
This is the case of a 58-year-old female patient presenting with a perforated appendix with an appendiceal abscess, treated by antibiotherapy and radiological drainage. She has a past history of uterine cancer treated by radiochemotherapy and total hysterectomy, complicated by bilateral ureteral stenoses after radiotherapy, treated by long-term pig-tail urinary catheters, as well as a postoperative abdominal hernia treated by means of an abdominal underlay mesh. Even though the initial non-surgical treatment of her complicated acute appendicitis was successful, an interval appendectomy was indicated because of persistent abdominal pain in the right lower quadrant (RLQ). The operation was performed laparoscopically with a simple postoperative course.
References:
1. Tannoury J. Abboud B. Treatment options of inflammatory appendiceal masses in adults. World J Gastroenterol 2013;19:3942-50.
2. McCutcheon BA, Chang DC, Marcus LP, Inui T, Noorbakhsh A, Schallhorn C, Parina R, Salazar FR, Talamini MA. Long-term outcomes of patients with nonsurgically managed uncomplicated appendicitis. J Am Coll Surg 2014;218:905-13.
3. Otake S, Suzuki N, Takahashi A, Toki F, Nishi A, Yamamoto H, Kuroiwa M, Kuwano H. Histological analysis of appendices removed during interval appendectomy after conservative management of pediatric patients with acute appendicitis with an inflammatory mass or abscess. Surg Today 2014;44:1400-5.
Laparoscopic appendectomy in a young woman, 22 weeks pregnant
This video is one of a series of laparoscopic appendicectomies. Additional pathologies are sometimes discovered during an appendectomy. One should be equally skilled to perform the necessary exploration and intervention by laparoscopy.
The authors use a few technical modifications in this 22-week pregnant patient. They place the left working trocar in the left flank, and the right in the right upper quadrant to avoid the gravid uterus, which occupies most of pelvis and lower abdomen. They examine the uterus and adnexa carefully to rule out any pathology before exposing the appendix. After they reach the base of the appendix and completely dissect the mesoappendix, they ligate the base of the appendix stump with two Vicryl loops. They place the extraction bag in the peritoneal cavity and divide the appendix at the base. Just before retrieving the appendix, the authors cauterize the appendicular stump.
The authors modify their typical laparoscopic approach to accommodate the pregnant woman’s anatomy. As they gain exposure of the appendix, the mesoappendix comes into view. They control the appendicular artery with bipolar coagulation. Sequential application of bipolar cautery and incision with scissors allows them to reach the base of the appendix. Once the authors completely dissect the mesoappendix, they ligate the base of the stump with a Vicryl loop.
D Varela, J Marescaux
Surgical intervention
12 years ago
1189 views
158 likes
0 comments
05:00
Laparoscopic appendectomy in a young woman, 22 weeks pregnant
This video is one of a series of laparoscopic appendicectomies. Additional pathologies are sometimes discovered during an appendectomy. One should be equally skilled to perform the necessary exploration and intervention by laparoscopy.
The authors use a few technical modifications in this 22-week pregnant patient. They place the left working trocar in the left flank, and the right in the right upper quadrant to avoid the gravid uterus, which occupies most of pelvis and lower abdomen. They examine the uterus and adnexa carefully to rule out any pathology before exposing the appendix. After they reach the base of the appendix and completely dissect the mesoappendix, they ligate the base of the appendix stump with two Vicryl loops. They place the extraction bag in the peritoneal cavity and divide the appendix at the base. Just before retrieving the appendix, the authors cauterize the appendicular stump.
The authors modify their typical laparoscopic approach to accommodate the pregnant woman’s anatomy. As they gain exposure of the appendix, the mesoappendix comes into view. They control the appendicular artery with bipolar coagulation. Sequential application of bipolar cautery and incision with scissors allows them to reach the base of the appendix. Once the authors completely dissect the mesoappendix, they ligate the base of the stump with a Vicryl loop.
Laparoscopic appendectomy for abscessed and necrotic appendix
This video of an emergency appendectomy demonstrates some of the advantages of the laparoscopic approach. Multiple abscess cavities are identified by a thorough exploration, including the necrotic appendix. Control of bleeding from the appendiceal artery and control of a gangrenous base of the appendix are clearly shown.

This male patient had emergency surgery after a 1-week history of diffuse abdominal pain with signs of inflammatory syndrome. CT showed a pelvic abscess.

The author begins the laparoscopic approach with a 1-cm incision just above the umbilicus and establishes pneumoperitoneum with the open technique. Dissection of the abscess must proceed cautiously. A suction device in tandem with a probe prove useful for continuing dissection to help mobilize the cecum.

As the appendix comes into view, the author identifies the mesoappendix to begin dissection. Significant edema makes it difficult to continue dissection with the blunt probe, so the author uses bipolar cautery to begin dissection of the mesoappendix.
A Rossini
Surgical intervention
12 years ago
10103 views
85 likes
0 comments
05:04
Laparoscopic appendectomy for abscessed and necrotic appendix
This video of an emergency appendectomy demonstrates some of the advantages of the laparoscopic approach. Multiple abscess cavities are identified by a thorough exploration, including the necrotic appendix. Control of bleeding from the appendiceal artery and control of a gangrenous base of the appendix are clearly shown.

This male patient had emergency surgery after a 1-week history of diffuse abdominal pain with signs of inflammatory syndrome. CT showed a pelvic abscess.

The author begins the laparoscopic approach with a 1-cm incision just above the umbilicus and establishes pneumoperitoneum with the open technique. Dissection of the abscess must proceed cautiously. A suction device in tandem with a probe prove useful for continuing dissection to help mobilize the cecum.

As the appendix comes into view, the author identifies the mesoappendix to begin dissection. Significant edema makes it difficult to continue dissection with the blunt probe, so the author uses bipolar cautery to begin dissection of the mesoappendix.