Laparoscopic Appendectomy Set Up
A laparoscopic appendectomy (AKA lap appy) is a case that every single circulator and surgical tech should know like the back of their hand— no matter what their specialty is. This is the type of case that gets added on in the middle of the night. This is the case that gets added to the room who finishes first (unless surgeon deems it an emergency, then someone’s getting bumped). I’ll go over my back table and mayo stand as well as talk about some of the disposables that should always be readily available.
Laparoscopic Appendectomy Back Table
Instrument pan; needle drivers, scissors, peon, S retractors, endocatch bag, adson tissue forceps, rat tooth forceps, additional laparoscopic instruments
Needle board
Med cup for local
Dermabond (2)
Suture (O-Vicryl UR-6 for closing the 12mm port, 4-0 Monocryl PS-2 for all port incisions)
20 cc syringe for local injection (a hypo should also be opened; the card called for an abnormal size, so I verified before opening)
Mayo scissors— I usually leave these in a very easy spot to grab instead of with the other instruments.
Basin with saline, extra towels, kidney basin with additional med cup, labels, marking pen, and cloth for scope warmer, gowns and gloves
*This surgeon requests that the endocatch bag be open from the beginning, I will say most others I work with ask you to hold it until after they’ve transected the appendix.
Laparoscopic Appendectomy Mayo Stand
Basic graspers (2)(some call these “wavy graspers” some call them “silver handle graspers”)
Maryland grasper
30 degree 5mm scope
0 degree 5mm scope placed in warmer (AKA igloo)
Knife handle with #11 blade
Towel clamps (2)
Insufflation needle would be next, however this patient was heavier and I wanted to check if the surgeon wanted long or regular length
5 mm non-bladed trocars (2)
12 mm non-bladed trocar
Peon
Raytecs
Ring Stand Contents (not pictured)
Light cord
Camera
Insufflation tubing
Suction/irrigator
Light handles
Laparotomy Drape
Towels/Sticky Drapes
Chloraprep (hand off to non-scrubbed person to prep- AORN best practice)
INTRAOPERATIVE TIP
INTRAOPERATIVE TIP
Fill your basin with NaCl from the irrigation set up BEFORE using it in the procedure— this will prevent reintroducing infection/contaminated tissue back into the peritoneum)
INTRAOPERATIVE TIP
INTRAOPERATIVE TIP
Laparoscopic Appendectomy | Items to have available
You will need to know the surgeon’s preference on how they transect the appendix. Most surgeons use an endo GIA stapler (same concept as open GIA staplers, but created for laparoscopic use). Some surgeons use Endo loops, which are essentially a loop of suture on a stick that they ‘lasso’ the appendix with. The endo loops are the cheapest, quickest, and easiest way (as long as the surgeon is a good lasso-er), however, studies show stapling has far better outcomes. A disposable scissor should be available, most pans contain a laparoscopic scissors but it seems that most surgeons prefer the disposable option which I imagine is based on the non-disposables always being dull. You should have whatever type of powered device the surgeon prefers (Enseal, ligasure, harmonic, etc.). Always have a laparotomy pan available. A handful of additional trocars (5mm, 12mm). A straight forward appy shouldn’t call for this, but I’ve seen more than enough chronically inflamed appys that require additional trocars (and time). These are the cases you should be prepared to convert to an open procedure— my ex lap set up is a good start for guidance. Some surgeons do the ‘drop test’ to verify placement of the insufflation needle into the peritoneum, so have a 3 cc syringe available— opened if you know they do the drop test. You should also have a suture passer or other type of port closure device (Carter-Thomason) available. Keep an additional 1,000 cc bag of saline in the event that one isn’t enough.
Fun fact— if a patient with appendicitis that’s been in excruciating pain all of a sudden feels better, there’s a good change their appendix ruptured. Which makes our job in the OR a little more complicated. This automatically changes the wound class from Class II (clean-contaminated) to a Class IV (dirty/infected).
