DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Rule out acute appendicitis.
POSTOPERATIVE DIAGNOSIS: Severe retrocecal appendicitis.
OPERATION PERFORMED: Laparoscopic appendectomy.
SURGEON: John Doe, MD
ANESTHESIA: General endotracheal anesthesia.
ESTIMATED BLOOD LOSS: Minimal. None transfused.
DRAINS: One.
SPECIMEN: Acutely, severely inflamed appendix.
OPERATIVE FINDINGS: Evidence of a very severe retrocecal appendicitis; otherwise, no other abnormalities were seen.
DESCRIPTION OF OPERATION: The patient was in the main operating room under adequate general endotracheal anesthesia. She had received Zosyn in the emergency department. A Foley catheter was placed. The left arm was then tucked and adequately padded. The entire abdomen was prepped with iodoform and draped in the usual sterile fashion.
A small infraumbilical incision was made and carried through the subcutaneous tissue down to the fascia, which was then cleaned off and elevated using Kocher forceps. A Veress needle was then placed through the fascia into the peritoneal cavity, where a positive saline test was obtained. Pneumoperitoneum was then established up to 17 mm of pressure, and a 12 mm trocar was then placed through this incision. A 0-degree, 10 mm laparoscope was then placed through this trocar.
Attention was initially directed to the superior viscera, where no gross abnormalities were seen. The patient was placed in steep Trendelenburg position, right side up. At this point, two 5 mm trocars were then placed, one at the suprapubic region and the other one in the left lower quadrant.
Using initially Endo-Kittners, the cecum was markedly adherent. Upon mobilizing the cecum, she was found to have a severely inflamed retrocecal appendicitis. At this point, using careful blunt and Harmonic scalpel dissection, we were able to dissect the appendix from the retroperitoneal structures. Great care was taken to stay away from the ascending colon.
Once having finally mobilized the retroperitoneum, the mesoappendix was then taken down using Harmonic scalpel, all the way down to the base of the appendix, which was then cleaned off. Subsequently, 5 mm camera was exchanged for a 5 mm scope, where subsequently a laparoscopic vascular staple was then placed through the 12 mm trocar. This was fired at the base of the appendix. The appendix was amputated, placed in endobag and removed through the umbilical port.
At this point, pneumoperitoneum was then reestablished again. The entire right lower quadrant region along with the pelvis was irrigated using close to almost 5000 mL of normal saline, with good clear aspirate return, as was also adequate hemostasis. At this point, the patient was leveled, all the saline was aspirated.
Next, all the trocars were then removed under direct visualization. No bleeding was encountered. The small infraumbilical fascia was approximated using interrupted 0 figure-of-eight PDS. All the incisions were infiltrated using 0.25% Marcaine. These were then approximated using 4-0 Vicryl along with Steri-Strips and a sterile dressing.
The estimated blood loss was minimal; none was transfused. No drains were placed. Sponge, needle, and instrument counts were correct on three occasions. The patient subsequently tolerated the procedure well, and she was then returned to the recovery room in a very stable condition.
