Laparoscopic AppendicectomyPort Positions and Importance of

Ergonomics

Dr.S.EaswaramoorthyMS FRCS(Eng) FRCS (Glas) FRCS (Edin)

Head of Dept of Minimal Access SurgeryExaminer, RCS of Edinburgh

Executive Member, South Zone IAGESIAGES Endoscopy Course Convener

Port placement for laparoscopic appendectomy with the best cosmesis and ergonomics. Surg Endosc. 2003 Jan;17(1):166-7

Port Positions• Preference of surgeon• Ergonomical reasons

– Age & build of the patient– Site of pathology

• Clinical & imaging criteria• Variable position of appendix

Ergonomics• Straight Line principle• Triangulation• Manipulation angle• Elevation angle• Low lying table• Gaze down view

Patient position and OT Set up

• Patient– Lying supine, head down & right side up

• Surgeon & Assistant– Standing on the patient’s left side

Straight Line Principle

Surgeon

PathologyMonitor

Camera Asst

Triangulation & Co Axial Alignment

C

S

C

Manipulation angle

Azimuth Angle Manipulation Angle

30-45 degree 60-90 degree

S

C

R

L

P

N

C: Camera S: SurgeonN: Nurse

Bikini Line Ports

• Lt supra pubic port: Optical port• Umbilical port: Rt hand dissection port• Rt supra pubic port: Lt hand retraction port

S

CN

Appendicectomy In a Child

L

RC

Camera Asst

Surgeon

Fulcrum Effect of Hand Instruments

1: 1

Along with Lap Cholecystectomy

C

During Pregnancy

1st Trimester 3rd Trimester

Situs Invertus

C

S

C

Monitor

2 port appendicectomy

C

SILS Appendicectomy

Acute appendicitis can be treated with single-incision laparoscopy: A systematic review of randomized controlled trials. Colorectal Dis. 2015 Apr;17(4):281-9Meta-analysis of randomized trials on single-incision laparoscopic versus conventional

laparoscopic appendectomy. Am J Surg. 2014 Apr;207(4):613-22.

TransvagainalNOTES Appendicectomy

Laparoscopic AppendicectomyPort Position & Ergonomics

IAGES Endoscopy Fellowship • 4 days of Didactic lectures, Hands on endoscopy

and Simulator training and assessment• November 3rd to 6th 2016 ( 4 days)• @ GI Unit, Lotus hospital, Erode, TN• Maximum of 50 candidates • For IAGES members only• Fee: 25000/- • See brochure/IAGES website• Contact : 09843328928 for details.