Diagnostic laparoscopy, explant of Angelchik device.
Operative Technique:
After obtaining informed consent, the patient was taken to the operating room and placed in the supine position. Following the smooth induction of general endotracheal anesthesia and a surgical time-out, the abdomen was prepped and draped in a standard and sterile manner. Hasson technique was utilized to enter the peritoneal cavity supraumbilically, and pneumoperitoneum was established to 15 mmHg. A 10mm, 30-degree laparoscope was introduced and intraabdominal adhesions were present throughout.
Fortunately, the left upper quadrant was relatively free of adhesions, and two 5 mm ports were placed in the left lateral abdomen under direct vision. Inspection in the epigastrium revealed a Silastic or silicone-appearing ring free-floating in the left upper quadrant. The right structure was consistent with an Angelchik device, and it was grasped by the tail and removed from the left upper quadrant through the Hasson port without difficulty. Inspection of the surgical field revealed excellent hemostasis.
Pneumoperitoneum was taken down under direct vision as the ports were removed. Port sites were irrigated and re-anesthetized, and the fascia at the Hasson site was closed with a 0 Vicryl employing 3 interrupted sutres. The skin was closed with a 4-0 Monocryl and sealed with skin glue.
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