Laparoscopic ultrasonography for localization of a retained appendicolith after appendectomy

Laparoscopy is becoming the preferred approach for various abdominal surgeries. The main limitation of laparoscopic surgery is difficult localization of lesions because of the loss of the surgeon's tactile sensation. Since the development of laparoscopic ultrasonography (LUS) probes that can be inserted through laparoscopic ports, LUS has been introduced to compensate for this limitation in various laparoscopic abdominal surgeries. Although the laparoscopic removal of appendicoliths is recommended in patients with retained appendicoliths after appendectomy for minimally invasive treatment, localization of the spilled appendicolith may be also an obstacle to surgeons using a laparoscopic approach. Appendicoliths are usually small, often surrounded by a necrotic rind of tissue, and sometimes located in inaccessible recesses of the peritoneum, making laparoscopic localization and removal technically difficult. In this report, we describe the use of LUS to facilitate intraoperative localization and removal of an appendicolith during laparoscopic abscess removal.