DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Transection of left ureter.
POSTOPERATIVE DIAGNOSIS: Transection of left ureter.
OPERATION PERFORMED:
1. Cystourethroscopy.
2. Left ureteral catheterization.
3. Exploratory laparotomy.
4. Left neoureterocystostomy.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, MD
ANESTHESIA: General endotracheal.
COMPLICATIONS: None.
INDICATIONS FOR OPERATION: The patient is a (XX)-year-old female, who was undergoing a LAVH, who sustained a left ureteral transection. This was proven with postoperative IVP. The above-listed procedure was recommended. Alternative treatments including the risks, benefits, and expected outcomes of each were discussed in detail with the patient. The patient desired to proceed with the planned operation.
DESCRIPTION OF OPERATION: After thorough preoperative evaluation, the patient was taken to the operating room and placed in the supine position on the operating room table. General endotracheal anesthesia was administered. When the patient was properly anesthetized, she was placed in dorsal lithotomy position, and the external genitalia and perineum were scrubbed with povidone-iodine scrub solution followed by povidone-iodine paint solution. The patient was then sterilely draped with towels and draped in usual fashion.
The 22-French cystoscope sheath and 30-degree lens with video camera were advanced through the urethra and into the bladder. The urethra appeared normal. The bladder wall was smooth. There was no evidence of lacerations, stones, tumor or other abnormalities. Attention was turned to the left ureteral orifice where a Pollack catheter was inserted inside the ureteral orifice and advanced up until resistance was met. This was measured to be approximately 5 cm from the ureteral orifice. The Pollack catheter was then eventually passed above that level and coiled in the pelvis. There appeared to be a complete transection of the ureter. At this point, the patient was left in a modified dorsal lithotomy position and the abdominal wall scrubbed with DuraPrep and sterilely draped with towels and drapes in the usual fashion.
A midline infraumbilical skin incision was made sharply down through the skin, fatty tissue, and then level of the fascia. The fascia was then divided superiorly and inferiorly and the peritoneal cavity entered. At this point, a large amount of urine was drained out of the peritoneal cavity and an exploration performed. The ureter was identified in the retroperitoneal space and followed down to its point of transection just inside the pelvic brim. It appeared as if a section of ureter of about 5 cm was completely removed. The end was freshened and was easily catheterized.
The bladder was freed from its position in the pelvis, filled with sterile water, and it appears as if an ureteroneocystostomy could be performed. The bladder was then opened, drained of any urine, and a cystostomy performed in the posterior left lateral wall of the bladder. The ureter was brought through the cystotomy incision, the end spatulated, and then sutured mucosa with interrupted 4-0 chromic sutures. The anastomosis provided a widely patent ureterovesical anastomosis. A 24 x 7 double-J stent was passed through the ureter up into the renal pelvis over a guidewire, which was eventually backed out forming a good coil in what appeared to be the renal pelvis as well as the patient’s bladder. Two supporting sutures of 3-0 Vicryl were then passed through the adventitial layer of the bladder to the ureter to keep tension minimized. The anastomosis appeared to be in no tension.
The cystostomy incision was then reapproximated and closed with a running 4-0 chromic suture followed by a running 2-0 chromic suture. The anastomosis was tested with filling the bladder with sterile water and no leaks were noted. The pelvis was then briskly irrigated with several 100 mL of sterile water and examined. No significant bleeding was noted. All the sponges were removed from the abdomen.
The fascia was reapproximated and closed with interrupted figure-of-eight Vicryl sutures followed by reapproximation of the subcutaneous tissue with 3-0 Vicryl sutures and closure of the skin with a skin stapler. A dry sterile dressing was placed over the wound. The patient was awakened, taken out of supine position, and returned to postanesthesia recovery room in stable condition.
