Laparoscopic appendicectomy, as with other laparoscopic techniques, requires a pneumoperitoneum to be created by the insufflation of carbon dioxide into the abdomen of the anaesthetised patient. A 10-12mm cannula below the umbilicus is used for the introduction of the laparoscope. Two further cannulae, one in the left iliac fossa and one over McBurney's point in the right iliac fossa, are used for access of dissecting instruments and grasping forceps respectively.
The appendix is held by the forceps and the vessels in the mesoappendix are divided with a diathermy hook. This continues as far as the appendix base, which is ligated with non-absorbable suture, pre-tied suture loops or clips. Then, it is cut distal to the ligature. Invagination of the appendiceal stump is not thought to offer any advantage.
The appendix is removed from the abdomen through the umbilical portal after the laparoscope is moved from this site to the left iliac fossa. Special extraction sheaths are available if the organ is swollen. A perforated or heavily infected appendix is removed with special specimen bags.
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