DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Acute appendicitis.
POSTOPERATIVE DIAGNOSIS: Necrotic/gangrenous appendicitis with microperforation.
OPERATION PERFORMED:
1. Laparoscopic appendectomy.
2. Peritoneal lavage.
ANESTHESIA: General.
ESTIMATED BLOOD LOSS: 5 mL.
The patient received IV Zosyn preoperatively, SCD for DVT prophylaxis, and Foley catheter intraoperatively.
DESCRIPTION OF PROCEDURE: Under satisfactory general anesthesia, the abdomen was prepped and draped in the usual sterile fashion. A Veress needle was inserted into the umbilicus with insufflation of the abdomen with CO2 to an intra-abdominal pressure of 15 mmHg. The Veress needle was removed and a 5 mm Surgiport was placed and the laparoscope passed.
Under direct laparoscopic visualization, the suprapubic 5 and 12 mm ports were placed. The patient was placed in the left lateral Trendelenburg position for better identification of the cecum and appendix. The terminal ileum was adherent to the right pelvis, and with manipulation and blunt adhesiolysis, the necrotic appendix was visualized up to the retroperitoneum. The adhesiolysis was performed freeing the necrotic appendix with elevation and dissection of the mesoappendix. The appendix was free for transection with Endo GIA stapler. The mesoappendix and appendix were transected and the appendix placed in an Endobag and withdrawn through the 12 mm port site to avoid wound contamination. Culture and sensitivities were obtained, and the appendix sent for pathologic evaluation.
Peritoneal lavage was performed until evacuated clear. There was no evidence of bleeding or leak. The 12 mm port site fascia was closed with 0 Vicryl using a Carter-Thomason and closed under direct laparoscopic visualization. Fascia was sutured and tied. The abdomen was deflated. All ports were removed. Each skin incision was anesthetized with 0.5% Marcaine and the skin closed with 4-0 Vicryl. Steri-Strips and Band-Aids were applied.
The patient tolerated the procedure well without complications and returned to the recovery room in satisfactory condition. The patient was maintained on intravenous Zosyn and Flagyl and analgesics postoperatively.
Laparoscopic Appendectomy Sample #2
DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Acute appendicitis.
POSTOPERATIVE DIAGNOSIS: Acute appendicitis.
OPERATION PERFORMED: Laparoscopic appendectomy.
SURGEON: John Doe, MD
ANESTHESIA: General.
FINDINGS: Inflamed appendix, no perforation, no abscess.
COMPLICATIONS: None.
ESTIMATED BLOOD LOSS: 10 mL.
DISPOSITION: Extubated, stable to recovery room.
DESCRIPTION OF OPERATION: After consent was obtained, the patient was brought back to the operating room and placed in the supine position. After induction of general anesthesia and endotracheal intubation, the patient’s abdomen was prepped and draped in the normal sterile fashion. Entrance was gained into the peritoneal cavity through an infraumbilical incision using a Veress needle technique.
After insufflation of the abdomen, a 12 mm port was placed through the incision using a laparoscope through the port for direct visualization on entry. After this, two 5 mm ports were then placed, one suprapubically in the midline and one in the left lower quadrant. Through these ports, the small bowel was pushed cephalad. The cecum was visualized and retracted. The base of the appendix was seen, and the appendix was gently separated from the surrounding bowel. There were some adhesions from the terminal ileum to the mesoappendix, which were gently taken down using blunt dissection. The cecum was mobilized laterally taking down the retroperitoneal attachments using a Harmonic scalpel. The mesoappendix was then taken using the Harmonic scalpel. Once the base of the appendix was freed out, 2-0 Vicryl endoloops were used to secure the base. The appendix was then transected above these loops using Harmonic scalpel, placed into an endo retrieval bag and retrieved through the infraumbilical incision. The port was replaced and the scope was advanced through the infraumbilical port.
The operative site was visualized. There was no active bleeding noted. There was no infectious material present. The surgical site was irrigated out and aspirated until clear. The pelvis was irrigated and aspirated until clear. All ports were removed. The fascia to the infraumbilical incision was closed with a figure-of-eight 0 Vicryl stitch. The skin was closed with interrupted 4-0 subcuticular Vicryl stitches, dressed with benzoin and Steri-Strips. The patient tolerated this procedure well, was extubated in the operating room, and transferred to the recovery room in stable condition. Sponge, needle, and instrument counts were correct at the end of the case.
Laparoscopic Appendectomy Sample #3
DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Polyp in the appendiceal orifice.
POSTOPERATIVE DIAGNOSIS: Polyp in the appendiceal orifice.
OPERATION PERFORMED: Laparoscopic appendectomy.
SURGEON: John Doe, MD
ANESTHESIA: General endotracheal.
SPECIMENS: Appendix and partial cecum.
ESTIMATED BLOOD LOSS: Minimal.
DRAINS: None.
DESCRIPTION OF OPERATION: The patient was taken to the operating room and given general anesthesia. Foley catheter was placed. The area of the abdomen was prepped and draped in the standard surgical fashion. An incision was made in the umbilicus with the use of a scalpel. A Veress needle was introduced into the abdominal cavity. The abdominal cavity was insufflated with CO2 gas. The 12 mm trocar was passed into the abdominal cavity without difficulty. The abdomen was then inspected. There was no evidence of any injury or bleeding at that time.
The abdomen was then reinsufflated. Additional 5 mm trocar was placed in the suprapubic position and one in the left lower quadrant after incisions were made and placed under direct visualization. The appendix was noted to be retrocecal. It was dissected free with use of sharp and blunt dissection. Once the appendix was freed from its attachments, it was held superiorly, and the area of the appendix-cecal junction was dissected free with the use of a curved Maryland dissector. Once that was dissected free, Endo-GIA stapler vascular load was placed on the cecum taking part of the cecum with the appendix. The stapler was fired. The staple line was noted to be intact without any bleeding, and the appendix was then grasped superiorly and the mesentery of the appendix was taken with additional reload of the vascular Endo-GIA. There was no evidence of any bleeding. The appendix was then placed in a bag and brought out through the umbilicus and passed off the field as specimen.
The specimen was opened. The polyp was noted to be at the appendiceal-cecal junction and noted to be grossly free margins. Next, the area was copiously irrigated. There was no evidence of any bleeding or anastomosis. The staple line appeared to be completely hemostatic, and under direct visualization, the 5 mm ports were removed. The camera was then removed from the umbilicus, and the abdomen was drained of CO2 gas. Once that was done, 0 Vicryl was used, figure-of-eight was placed in the umbilical port site, and the subcutaneous tissue was irrigated and skin was approximated with 4-0 Monocryl. The 5 mm sites of the skin was approximated with 4-0 Monocryl interrupted. Areas were cleaned and dried. Benzoin was applied. Steri-Strips were applied. A cotton ball with bacitracin was applied to the umbilicus, and a sterile Tegaderm was placed. The patient was awoken, Foley catheter was removed, and transported to the recovery room alert and awake in stable condition. All sponge and instruments were correct at the end of the case.
