Laparoscopic Appendectomy Instrument Tray

Don’t Leave it Till the Appendix: Laparoscopic Appendectomy Instrument Tray

by Brie Eteson, Medical Communications, Digital Surgery

Appendicitis is a common condition, occurring in around 1 in 20 people in the US at some point in their lives.1 Surgical treatment for this condition is by removal of the inflamed or infected appendix. The procedure can be performed either open or laparoscopic, and is not considered to cause significant long-term problems.

Knowledge of surgical instrument trays is essential for all operating room staff to ensure effective support is given to the surgeon.

There is a long list of instrumentation to get to grips with, so Touch Surgery™ is coming to the rescue with our simulation on a typical instrument tray you might use for a laparoscopic appendectomy.

Our module takes you through all the standard instrumentation and their functions, keeping in mind that surgeons’ preferences and institutional protocols may vary. All members of the operating team should be familiar with the safe use of the instrumentation and equipment.

Instrument Tray

The module introduces the following instruments:

Consumables

  • 10×10 cm gauze swabs to control bleeding
  • Tonsil swabs, also to control bleeding
  • Sharps pad for discarded sharps
  • Scratch pad for cleaning tissue or debris off electrosurgical instruments
  • Swab counting bag for counting, handling, and disposing of contaminated swabs
  • Anti-fogging agent for the laparoscope lens
  • Filtered needles to be used with syringes to aspirate solutions
  • Gallipot containers for liquids, specimens, and waste
  • Kidney dishes to safely collect medical waste
  • Laparoscope warmer for preventing fog and condensation on the distal lens
  • Sterile camera cover to maintain sterility of the attachment
  • Wound dressings to cover the trocar sites at the end of the procedure
  • Steristrips (sterilized surgical tape) for wound closure
  • Size 1 absorbable synthetic braided sutures with J-needles for the Hasson port
  • Size 4-0 monofilament absorbable synthetic sutures for closing skin incisions

Anesthesia

  • Bupivacaine 0.25% with epinephrine 1:200,000 to create a transversus abdominis plane (TAP) block
  • Lidocaine to infiltrate the trocar site during skin closure
Scratch pad

Scratch pad

Absorbable synthetic braided suture with J-needle

Absorbable synthetic braided suture with J-needle

Operating Instruments

  • Number 15 blade with a small curved cutting edge for short, precise incisions
  • Handheld diathermy or monopolar electrocautery pen for cutting soft tissue and cauterizing small vessels
  • Right-angled Langenbeck retractors to retract skin and subcutaneous tissue, and to expose anterior fascia
  • Allis tissue forceps for grasping the peritoneum, and placement of stay sutures
  • Curved Mayo scissors for incising the anterior fascia during Hasson port insertion
  • Needle holder with ratchets to grasp the body of the needle
  • Hasson port with blunt tip and wings to anchor stay sutures
  • 30° laparoscope with an angled lens for abdominal laparoscopy
  • Two 5 mm trocars for the other instruments
  • Atraumatic fenestrated graspers and atraumatic graspers with serrated jaws for handling soft tissue
  • Disposable electrocautery hook with a right-angled tip for general dissection
  • Laparoscopic clip applicator for ligating the appendiceal artery and the base of the appendix
  • Loops for ligating the base of the appendix
  • Laparoscopic scissors for dividing the appendix at the base
  • Suction irrigation cannula connected to a suction pump and an irrigation solution
  • Specimen bag enclosed within a cannula to remove of the amputated appendix

Additional Equipment

  • Compression boots
  • Leg straps
  • Diathermy pad
Handheld diathermy

Handheld diathermy

Number 15 scalpel blade

Head over to the Touch Surgery™ app  to get a better look at these instruments!

Launch in App

References

1. WebMD. Appendicitis. WebMD Website. https://www.webmd.com/digestive-disorders/digestive-diseases-appendicitis. Accessed Nov. 19, 2020.

2. Rutherford CJ. Differentiating surgical instruments. 2nd ed. Philadelphia, PA: FA Davis Company; 2011.

3. Korndorffer JR, Fellinger E, Reed W. SAGES guideline for laparoscopic appendectomy. Surgical endoscopy. https://www.sages.org/publications/guidelines/guidelines-for-laparoscopic-appendectomy/. 2010;24(4):757-61. Accessed on Mar. 11, 2019.