DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Left renal mass.
POSTOPERATIVE DIAGNOSIS: Left renal cell carcinoma.
OPERATION PERFORMED: Cryoablation of lesion.
SURGEON: John Doe, MD
ESTIMATED BLOOD LOSS: Minimal.
DRAINS: Foley catheter.
INDICATION FOR OPERATION: The patient was found to have an incidental left renal mass measuring roughly 3 cm in size. The patient was counseled as to the various options and chose to undergo cryoablation of the lesion rather than any type of excision of the mass or radical nephrectomy. The patient was warned of the risks of recurrence of disease and need for careful monitoring. He understood and wished to proceed. The patient was also warned of the possibilities of need for removal of the kidney during surgical exploration. The patient understood and wished to proceed.
DESCRIPTION OF OPERATION: The patient was brought to the operating room after anesthesia was placed in the supine position. He was prepped and draped in the sterile fashion. A midline periumbilical incision was made and carried into the peritoneal cavity. A gel pack was sized and appropriately placed and the seal created. After this was performed, through the seal the peritoneal cavity was insufflated with carbon dioxide. Following this, the port was placed for visualization. Two other separate small incisions were made in the anterior abdomen, and using the self-dilating ports, two other access ports were placed under visual inspection. No evidence of bowel injury was noted.
At this point, dissection was carried laterally to the white line of Toldt on the left side, and the dissection was carried down to the Gerota fascia, which was then carefully examined. The left renal mass could be palpated, and dissection of the Gerota fascia overlying the mass was performed. Following this, a separate stab wound was made in the flank and through the stab wound a biopsy gun placed. Under careful visualization, the tip of the biopsy probe was placed within the renal mass. Two biopsies were taken and sent for pathology, where frozen section confirmed the diagnosis of renal cell carcinoma.
At this time, a 2 cm cryoprobe was then placed through that separate incision into the renal mass. Freezing of the mass was then performed, two cycles with a freeze of six minutes followed by a passive thaw, followed by a second freeze with an active thaw with helium. Following completion, the probe was removed, and the hole was filled with FloSeal. Then, the whole mass packed over with Gelfoam. The lesion was then inspected for a while and no evidence of bleeding noted.
Bowel reapproximated in the previous normal anatomical position. Under visualization, we removed the ports and then the gel pack. We then closed the midline incision with a running #1 PDS stitch. Skin was closed with staples. The patient was injected with 0.5% Marcaine. He was then awakened and brought to the recovery room in stable condition.
