DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Chronic cholecystitis.
2. Cholelithiasis.
3. Fatty infiltration of liver.
POSTOPERATIVE DIAGNOSES:
1. Chronic cholecystitis.
2. Cholelithiasis.
3. Fatty infiltration of liver.
OPERATION PERFORMED:
1. Laparoscopic cholecystectomy.
2. Wedge biopsy, right lobe of liver.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, PA-C
ANESTHESIA: General endotracheal.
FINDINGS AND DESCRIPTION OF OPERATIVE PROCEDURE: After proper consent was obtained, the patient was brought to the operating room and placed on the table in the supine position. General endotracheal anesthesia was administered. The abdomen was prepped and draped in the sterile manner. Then, 0.5% plain Marcaine solution was injected for local anesthesia in the perioperative regions.
Incision was made in the infraumbilical region with a #15 blade large enough to accommodate the Hasson trocar. Dissection was carried down with cautery through the subcutaneous tissues down to the fascia. Then, 0 Vicryl sutures were placed in the fascia, and it was elevated up into the incision and opened under direct vision with the #15 blade. The underlying peritoneum was grasped between hemostats and opened sharply.
The retractor was placed. The Hasson trocar was inserted and secured in place, and the abdomen was insufflated. A 5 mm trocar was placed in the subxiphoid and in the right upper quadrant regions of the abdomen under direct vision. The gallbladder was grasped at the fundus and the neck with graspers. The Harmonic dissector was used to dissect some adhesions of omentum down away from the gallbladder.
The peritoneal layer was then opened on the right lateral side of the gallbladder and mobilized away from the gallbladder. Kitners were then used to further mobilize this chronic inflammatory tissue away from the gallbladder. The cystic duct and cystic artery were completely skeletonized. The cystic artery was divided at its confluence with the gallbladder surface using the Harmonic dissector, and good hemostasis was noted. All tissues between the cystic duct, the gallbladder, and the liver edge were completely dissected free to assure no abnormal anatomy.
The cystic duct was then clipped at its confluence with the gallbladder and then opened on the anterior surface. A cholangiocatheter was attempted to be placed, and it appeared that it would not pass and gentle milking motion of the cystic duct from distal to proximal revealed that there were three small stones within the cystic duct. The cholangiocatheter was then inserted and a clip was placed; however, there was reflux of contrast back out from around the clip and the catheter, and successful placement of the catheter without extravasation could not be obtained, and therefore, further attempts at cholangiogram were aborted.
The cystic duct stump was clipped and then also tied with 0 PDS Endoloop. The gallbladder was dissected free from the liver bed using Harmonic dissection and removed using an endobag. The right lobe of the liver was biopsied using Harmonic dissection to take a wedge of liver tissue because the liver had a diffuse fatty infiltrative appearance. The wedge specimen was brought out through the Hasson trocar site using an endobag, as well also under direct vision with a 5 mm camera.
The operative areas were inspected and rendered hemostatic with cautery as needed and then irrigated. All irrigant was suctioned from the abdomen. The 5 mm trocars were then removed under direct vision with no hemorrhage noted. The Hasson trocar was removed, and the abdomen was desufflated.
The fascia at the Hasson trocar site was closed with 0 Vicryl suture. This was tied, and palpation revealed good closure. The skin incisions were closed with subcuticular 4-0 Vicryl sutures. Benzoin, Steri-Strips, and sterile gauze dressings were placed. The patient had his anesthesia reversed, and he was taken to the recovery area postoperatively.
