Complete two-handed laparoscopic appendectomy: report of 100 cases.

A complete two-handed technique for laparoscopic appendectomy is described. From April 1992 to July 1994, 100 patients with suspected acute appendicitis were selected to undergo this approach. This technique allows the surgeon to manipulate instruments with both hands for dissecting, transecting and removing the appendix. The appropriate placement of three cannulas in the lower abdominal midline makes this technique possible. Monopolar cautery is used to dissect the mesoappendix and to cauterize the appendicular vessels. Two ligatures are placed at the junction of the appendix with the cecum. The appendix is clamped at its base by ratchet forceps and is extracted along with the forceps immediately after transection. None of the patients selected for this procedure required conversion to open appendectomy. Postoperative complications occurred in four patients, two with umbilical wound infections and two with intra-abdominal abscesses; 12 patients had perforated appendicitis. The results of this study suggest that a complete two-handed laparoscopic appendectomy can be safely and successfully accomplished in patients with suspected acute appendicitis.