Retroperitoneum and Ureters Exploration Operative Sample Report
DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Huge retroperitoneal tumor, probable gynecological origin.
2. Duplicated left renal collecting system.
3. Distortion of intra-abdominal anatomy.
POSTOPERATIVE DIAGNOSES:
1. Huge 5680 gram (26 x 25 x 16 cm) retroperitoneal fibroid tumor from the left side of the uterus.
2. Distortion of the pelvic anatomy.
3. Duplicated left renal collecting system.
4. Meckel diverticulum with ectopic tissue.
5. Normal-appearing appendix.
OPERATION PERFORMED:
1. Exploration of the retroperitoneum and ureters.
2. Resection of huge left retroperitoneal tumor with control of retroperitoneal bleeding.
3. Meckel diverticulectomy with oversewing of Meckel diverticulum.
4. Placement of left retroperitoneal drain.
SURGEON: John Doe, MD
ANESTHESIA: General endotracheal.
ESTIMATED BLOOD LOSS: 100 mL.
COMPLICATIONS: None.
DESCRIPTION OF OPERATION: The patient was already under general anesthesia with open midline incision noted. Upon entering into the abdomen, a huge 26 x 25 x 16 cm tumor was noted to distort the entire anatomy, and this could be birthed into the incision. The cervix and uterus were distorted into the right lower quadrant. The tumor occupied the entire retroperitoneum of the left lower quadrant. No retroperitoneal stents could be noted. Gynecology stated no preoperative urethral stents were replaced. The IVP was noted to be hanging on the wall. The sigmoid colon was noted to be attached and involved within the tumor.
The sigmoid colon was followed down. It was separated, using Bovie electrocautery, from the huge tumor. A plane could be noted between the tumor and the sigmoid colon, consistent with non-bowel origin of the retroperitoneal mass. The retroperitoneum was entered and the dissection stayed against the tumor and mobilized the tumor anteriorly. The duplicate urinary system was identified throughout its entire course and remained intact.
The peritoneum was incised circumferentially around the tumor. The right ovarian pedicle and ovary were transected by Gynecology. The tumor was birthed into the incision and separated from the retroperitoneum. Retroperitoneal bleeding sites were controlled using 0-Vicryl suture ties, and the tumor was removed and en bloc and sent to pathology as a specimen including the left ovary, tube, and part of the left uterus. Pathology revealed a 5680 gram tumor, 26 x 25 x 16 cm in size, involving the left retroperitoneum.
Meticulous hemostasis of the left retroperitoneum was ensured. Copious irrigation of the abdomen was performed. All bleeding points were controlled. A J-VAC was placed into the left pelvis, exiting the left lower quadrant, sewn to the skin using 2-0 nylon. The drain was attached to bulb suction. During cleansing of the abdomen, a large mass was noted to be on the small bowel. This was noted to be a huge diverticulum, approximately 5 inches in length, with an abnormal mass at its tip consistent with ectopic tissue. The Meckel diverticulum was transected using a GIA 55 stapler. The suture line was oversewn using 3-0 silk ties in an interrupted fashion. It was sent to pathology as a specimen.
Meticulous hemostasis was assured of all bleeding points, and the ureters were once again inspected and found to be intact throughout their entire course on both sides. Gynecology closed the abdomen.
