Laparoscopic Appendectomy in Pediatric Patient

Aaradhya Sharma

https://www.laparoscopyhospital.com/SERV01.HTM  This video demonstrates Laparoscopic Appendectomy in Pediatric Patient perform by Dr. R.K. Mishra at World Laparoscopy Hospital. Laparoscopic appendectomy is safe and effective in treating children with suspected appendicitis. It may be safely performed as fast-track or same-day surgery, in select children without perforated appendicitis, with a postoperative stay of ≥24 hours in the majority of such patients. The recurrence of appendicitis caused by an infection -re the usual reasons for removal.  The laparoscopic technique seems to be safer than open appendectomy for acute appendicitis in children. The laparoscopic approach is most frequently used, except for young children. Superficial surgical site infections are more frequent after open surgery only in patients with complicated appendicitis. The normal appendix rate is low, most likely because of routine preoperative imaging.  For more information please contact:  World Laparoscopy Hospital  Cyber City, Gurugram, NCR DELHI  INDIA 122002  Phone & WhatsApp: +919811416838, + 91 9999677788

Transcript

00:00hello friends this is a three year old child and this is a girl child with having the acute

00:09appendicitis although we have performed the surgery in very early stage and it may be only

00:16in the catarrhal stage so it was easy to perform and there was no lump formation and no any other

00:23complication so we will this is the target and we will perform by the two port one 10 mm port was

00:32introduced into the nfa crisa from lycas one three millimeter port that is to the supra pubic and one

00:40a striker mini alligator we have used so a striker mini alligator is not considered as a port because

00:47it is a instrument which can be introduced directly through the abdominal wall and percutaneously so

00:54we consider it as a micro instrument without port so this is a striker mini alligator which is giving

01:00the traction that is the anteromedial traction and then you can start separating the major appendix

01:08this is the major appendix and this is harmonic scalpel teflon jaw of the harmonic scalpel is

01:14kept towards the appendix and with the vibrating jaw we will separate the major appendix and will cook

01:21the appendicular artery as we know harmonic scalpel is a good dissector and it can separate but teflon jaw

01:30should be touching the appendix in cases of the pediatric cases your tissue is very soft so you have to be

01:36careful another important thing is the structures are very readily visible because peritoneum is almost transparent

01:48and the vessels are also clearly visible through the peritoneum

01:54so dissection is easy but delicate we should try to reach completely up to the base of the appendix

02:02so that any portion of the appendix should not be left behind because incomplete appendicectomy is one

02:10of the complication especially in pediatric cases because sometimes we hesitate going up to the base of the

02:16cecum so the this is a combination of the blunt dissection so that it should be completely mobilized from all

02:24around and we can reach up to the base of the appendix

02:30now you can take a misrage knot this is the misrage knot and this is a knot pusher

02:54so you can bring the loop inside and this striker mini alligator will be now introduced into this loop

03:10after that you will go behind the structure

03:13and this loop will be negotiated to reach up to the base of the appendix

03:27once the loop is shortened then the tip of the knot pusher should be brought over the junction

03:34it is very important that you should push it down so that it will go at the junction itself

03:40wherever you will use the tip of the knot pusher automatically the entire loop will shrink there

03:47and pushing should be equal one hand will push the knot pusher another will pull the suture

03:54this should be done three times and once the knot is ligated with the seizures you can cut the suture

04:03so one knot is more than sufficient because knots are either exactly right or hopelessly wrong

04:10so correctly right ligated one knot is more than sufficient now with the harmonic we will cut the

04:17remaining appendix it will seal the upper end so there will not be any spillage and it will burn the mucosa

04:24also now we will change the telescope to 10 mm from 10 mm to 5 mm now this is 5 mm telescope in the

04:33suprapivic region and then this is the appendix coming out through the umbilical 10 mm port because

04:4110 mm is required to retrieve so that will be useful so this is slowly coming and then you will bring the

04:49appendix completely into the cannula and then cannula also will be taken out so thank you very much for

04:58watching this video this was just a simple case of acute appendixitis in a pediatric case

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