An improved technique for laparoscopic appendectomy based on an experi
ence of > 120 cases is presented. This method includes numerous additi
ons to and modifications of previously described techniques and is eff
ective for gangrenous and perforated appendicitis as well as for less
severe cases. The most important elements are that (a) it is a safer p
rocedure for attaining insertion of the Veress needle and the primary
trocar; (b) it employs electrocautery to separate the appendix from th
e mesoappendix; (c) an Endosac can be used for removal of the appendix
from the abdomen without contamination of the abdominal wall; (d) no
laser is necessary; and (e) staples are rarely necessary.