DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: End-stage renal disease, recurrent infection, right kidney.
POSTOPERATIVE DIAGNOSIS: End-stage renal disease, recurrent infection, right kidney.
OPERATION PERFORMED:
1. Laparoscopic exploration.
2. Right-sided laparoscopic nephrectomy.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, MD
ESTIMATED BLOOD LOSS: Less than 100 mL.
COMPLICATIONS: None.
SPONGE AND NEEDLE COUNT: Correct.
INDICATIONS FOR OPERATION: This is an adult male with a history of end-stage renal disease requiring hemodialysis. The patient presents today for elective right-sided nephrectomy secondary to recurrent infections and possibility of future live donor transplantation.
DESCRIPTION OF OPERATION: After a lengthy discussion of the risks, benefits and procedures, the patient was taken to the operating room and appropriate endotracheal anesthesia was induced without any comments or complications. The patient was put into a left decubitus position, and the right abdomen was prepped appropriately in a sterile fashion using DuraPrep. At this point in time, the patient had two right upper quadrant ports placed using an open technique in the midclavicular and midaxillary line. A third 5 mm port was carefully placed in the right upper quadrant under direct visualization.
At this point in time, pneumoperitoneum was created using CO2 insufflation to 15 mmHg. Upon completion of this and extensive exploration of the peritoneal cavity, there were no abnormalities. The right kidney was noted to have a large amount of inflammatory response around it and was adhesed to the lateral sidewall as well as the adrenal gland. A hand port was carefully put into position. This was measured to be approximately 7 cm, and the incision was carried down through the fascial layers using electrocautery. The retractor was put into position.
From this point, we began by first mobilizing the lateral attachments of the right kidney. Upon completion of the ureter, the pedicle was carefully identified, and a Harmonic scalpel was used to carefully circumferentially dissect around this. The ureter as well as vessels was carefully divided using a vascular stapler load. The kidney was then carefully mobilized using the Harmonic scalpel, first at the level of the upper pole, and the adrenal gland was carefully dissected off the upper pole of the kidney without any complications. The lateral attachments were carefully taken down.
At this point in time, the duodenum was carefully tracked in a medial fashion with care being taken to avoid injury to the duodenum itself. The vena cava was thus identified, as was the right renal vein. The right renal artery was also carefully identified. At this point in time, the kidney was fully mobilized, except for its vascular pedicle. The vascular pedicle was then carefully identified using a laparoscopic vascular stapler and then removed from the hand port. Repeat inspection failed to reveal evidence of any other abnormalities, and there was noted to be excellent hemostasis. There was no evidence of hollow viscus injury.
All ports were then carefully removed. The fascia at the 12 mm port was carefully reapproximated using 0 Vicryl figure-of-eight stitch. The hand port site was carefully closed in two layers of 0 PDS running suture. The skin incisions were carefully reapproximated using 4-0 Monocryl in a running subcuticular stitch. Appropriate sterile dressings were applied. The patient tolerated the procedure well with no complications during the case. The patient was extubated in the operating room and taken to the postoperative recovery in stable condition.
