Trans-laparoscopic appendectomy is a procedure that has been gradually introduced in recent years. The procedure is able to reduce the patient’s pain to a great extent. It is less invasive and has a faster recovery. It is very popular among patients. For a long time, open appendectomy has been a reliable and effective method for the treatment of acute appendicitis. However, in clinical practice, the misdiagnosis rate of acute appendicitis is 30%, higher in female patients, and the negative appendectomy rate is also as high as 20-30%. For patients with right lower abdominal pain of unknown diagnosis, a clear preoperative diagnosis is crucial. In conventional surgery, a comprehensive exploration to clarify the diagnosis is not possible due to the small incision and limited exposure of the surgical field. Laparoscopic appendectomy can improve the diagnosis of right lower abdominal acute abdomen with a broader intraoperative field of view, allowing the operator to better visualize the pelvis, large and small bowel, and most intra-abdominal organs. Six meta-analyses and more than 35 randomized clinical studies have confirmed the accuracy of laparoscopic exploration over conventional surgery. Laparoscopic appendectomy is not currently the gold standard procedure for acute appendicitis and perforated appendicitis, but like other laparoscopic procedures, its safety and feasibility are unquestionable. The decision to adopt this procedure depends on the patient’s condition, the hospital’s equipment and the surgeon’s laparoscopic skill level.