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.