DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Colon cancer.
POSTOPERATIVE DIAGNOSIS: Colon cancer.
OPERATION PERFORMED: Laparoscopic right hemicolectomy.
SURGEON: John Doe, MD
ANESTHESIA: General endotracheal.
SPECIMENS: Right hemicolectomy.
ESTIMATED BLOOD LOSS: Less than 200 mL.
DRAINS: None.
DESCRIPTION OF OPERATION: After the patient was consented for laparoscopic right hemicolectomy, the patient was taken to the operating room and given general endotracheal anesthesia. He was placed in the supine position. A Foley catheter was placed. The abdomen was prepped and draped in the standard surgical fashion. Incision was carried down in the umbilicus approximately half inch in length with the use of a scalpel. A Veress needle was introduced. The abdominal cavity was insufflated with CO2 gas.
Next, 12 mm bladeless trocar was introduced into the abdominal cavity with ease. The abdominal cavity was then reinsufflated. A 10 mm, 30 degree scope was placed in the abdominal cavity. There was no evidence of any injury from the Veress needle or trocar. An additional 5 mm trocar was placed in the suprapubic position after a small stab incision was created with a 15 blade. This was placed under direct visualization and the exact same procedure was carried out with a 5 mm trocar in the left flank.
Upon inspection of the abdomen, the patient was noted to have a large mass at the hepatic flexure, also noted to have a large mass at the distal appendix. The mass was noted to extend under the liver bed, which was densely adherent to the liver. Next, the ileocolic artery was identified and taken with the use of the Ace Harmonic scalpel. The retroperitoneal dissection was carried up to the level of the hepatic flexure. Following that, the terminal ileum was mobilized and the right paracolic reflections were taken down along the line of Toldt with the use of the Ace Harmonic scalpel.
Using an additional 5 mm trocar, which was placed up in the left upper quadrant after a small stab incision was created, the liver was retracted superiorly and the attachments of the transverse colon were taken down with use of sharp dissection. The omentum was taken off of the transverse colon to the level of the mid transverse colon. The right colic artery was identified and taken with the use of the Ace Harmonic scalpel. The duodenum was identified and mobilized medially.
Once the colon was completely mobilized to the level of the mid to distal transverse colon, the 5 mm trocars were removed. The terminal ileum was grasped with a grasper, and the incision through the umbilicus was extended to approximately 3-1/2 inches in length with the use of cautery. A retractor was placed into the wound.
The bowel, including the terminal ileum, right colon and transverse colon, were brought up through the incision. The terminal ileum, approximately 15 cm proximal to the ileocecal valve, was transected with a 75 GIA stapler and the mid transverse colon was transected in a similar fashion. The mesentery was taken with the use of Ace Harmonic scalpel. The specimen was passed off the field, labeled as right colon, and there was noted to be a large mass with several large lymph nodes adherent to it.
Next, a functional side-to-side anastomosis was created with a 75 GIA stapler followed by closure with a TA60. The created anastomosis was reinforced with 3-0 Vicryl pop-off interrupted. The staple line was reinforced with 3-0 Vicryl pop-off interrupted in a Lembert fashion. The bowel was then returned to the abdominal cavity. The omentum was draped over the bowel. The abdomen was then copiously irrigated. There was no evidence of any bleeding. A sheet of Seprafilm was placed in the abdominal cavity.
The fascia was approximated with #1 PDS in a running fashion. Subcutaneous tissue was copiously irrigated and the skin was approximated with staples. The trocar sites were approximated with staples as well. The abdomen was cleaned and dried. Dry sterile dressings were applied. The patient was awakened, extubated, and transported to the recovery room alert, awake, and in stable condition. All sponge and instrument counts were correct at the end of the case.
