SURGICAL Techniques

Elective laparoscopic appendectomy
in gynecologic surgery:
When, why, and how

This operation may be beneficial in certain populations of women,
provided the surgeon has the necessary expertise and counsels the patient
thoroughly before proceeding

Watch 3 intraoperative videos Dissect the appendix Resect the appendix Remove the specimen Videos provided by Teresa Tam, MD, and Gerald Harkins, MD

Dr. Tam is a Fellow in the Division of Urogynecology and Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, Pennsylvania.

Dr. Harkins is the Fellowship Director in the Division of Urogynecology and Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine.

Dr. Tam reports no financial relationships relevant to this article. Dr. Harkins is a consultant to Ethicon and Intuitive Surgical.

CASE: Should appendectomy be included in total
laparoscopic hysterectomy?

A 39-year-old mother of two continues to experience severe dysmenorrhea and persistent menorrhagia despite undergoing endometrial ablation 2 years earlier. Her obstetric and gynecologic history is remarkable for a diagnosis of chronic pelvic pain, endometriosis, and failed endometrial ablation. Both her children were delivered by cesarean, and she has undergone tubal ligation. She requests hysterectomy to address the dysmenorrhea and menorrhagia once and for all.

A pelvic exam reveals an anteverted, 10-weeks’ size uterus with no adnexal masses or tenderness. After extensive discussion of the surgical procedure, the patient signs a consent for total laparoscopic hysterectomy.

Would you recommend appendectomy, too?