DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Carcinoma of the left kidney.
POSTOPERATIVE DIAGNOSIS: Carcinoma of the left kidney.
OPERATION PERFORMED: Hand-assisted laparoscopic nephrectomy.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, MD
ANESTHESIA: General.
DESCRIPTION OF OPERATION: The patient was brought to the operating room, placed on the table in the supine position, then turned into the left flank position, and rolled back into the supine position. An incision just lateral to the midline, superior to the umbilicus, was performed on the right side of the abdomen and carried through the subcutaneous tissue onto the anterior rectus sheath, which was incised. The rectus muscles were then divided in the midline. The peritoneal cavity was entered and inspected. A huge tumor was noted in the left retroperitoneal space.
Following the insertion of ports, a hand-assisted laparoscopic nephrectomy was performed, the colon was identified and pulled medially, incision made along the white line of Toldt, and the colon reflected medially and inferiorly. Retroperitoneal space was entered. Dissection was carried around the lower pole of the left kidney and then cephalad around the upper pole. Large lower pole tumor was identified. Hypervascularity was present. Vessels were coagulated with the bipolar electrode or clamped, ligated, and divided with clips. The hilum was identified, and metallic clips were placed across the hilum and the stapling procedure performed, dividing the renal artery and renal vein. The adhesions and connections to adjacent tissues of the left kidney were then divided and the kidney separated from the surrounding structures with the exception of the ureter, which was then doubly clamped, ligated, and divided. Good hemostasis was achieved. Inspection of the peritoneal cavity confirmed good degree of hemostasis.
The incision was then increased in size and extended in a cephalad fashion, allowing delivery of the huge kidney tumor, which was subsequently sent for pathologic examination. The fascial layers were then closed with interrupted 0 Vicryl sutures. The subcutaneous tissue was closed with 3-0 Dexon and subcuticular suture of 4-0 Monocryl was performed. Steri-Strips and a dry sterile dressing were applied. The patient tolerated the procedure well and was returned to the recovery room in satisfactory condition.
