Pure Transvaginal Laparoscopic Appendectomy

Kurt E Roberts, MD, Dan-Arin Silasi, MD, Robert L Bell, MD, Andrew J Diffy, MD. Yale School of Medicine

This video presentation is from a 37 yo female who underwent a pure transvaginal laparoscopic appendectomy. This is one out of 14 successfully performed pure transvaginal appendectomies at Yale-New Haven Hospital. Appropriate Institutional Review Board was obtained preoperatively.

The patient was positioned in steep Trendelenberg position at which time a weighted speculum was introduced into the vagina allowing exposure of the posterior vaginal fornix. The cervix was grasped with a single-toothed tenaculum on the posterior cervical lip and the posterior vaginal fornix was brought into the operative field. Access to the peritoneum was achieved by electrocautery and sharp dissection. After access into the peritoneum was established, a SILS port was introduced and pneumoperitoneum up to 15mmHg was achieved. Two 5mm trocars and one 12mm trocar were used. A 5mm 30 degree angled endoscope, a flexible reticulating endograsper and straight standard instruments were used. The appendix identified dissected and a stapler was used to divide the mesoappendix and the appendix from its base. Following confirmation of good hemostasis and no spillage of bowel contents, the appendix was removed within a retrieval bag from the abdomen and the colpotomy closed with a running absorbable suture. The patient tolerated the 27 min procedure well and was discharged home in good condition on POD#1.

We have successfully demonstrated the feasibility and safety of pure transvaginal laparoscopic appendectomy without any abdominal incisions whatsoever in 14 female patients. This video presents one of these patients. It is safe and well tolerated with only minimal need for postoperative pain control. It allows for rapid return to daily activities while providing a most favorable cosmetic outcome for women. More extensive studies evaluating the benefits and also identifying possible complications are necessary to confirm our promising early results.

Session: SS03
Program Number: V011

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