Laparoscopic appendectomy for acute appendicitis: How to discourage surgeons using inadequate therapy

Figure 3 Key techniques during laparoscopic appendectomy. A: Appendiceal vessels should be clearly dissected and be sealed without a clip for subsequent use of an endostaple; B: Total resection of the appendiceal root should be made (red solid arrow). A flexible endostaple has an advantage in extended resection to the cecum (red dotted arrow); C: The ileocecal valve should be recognized before an endostaple is placed (red arrow). Any involvement of this valve should be avoided; D: The externally-inverted staple line should be carefully checked. If there is any concern about a stump, a couple of interrupted seromuscular sutures can be added. Unrelated and spilled staples (blue arrow) should be removed.