DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS:
Colonic mass.
POSTOPERATIVE DIAGNOSIS:
Colonic mass.
OPERATION PERFORMED:
Minimally invasive extended right hemicolectomy.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, MD
ANESTHESIA: General endotracheal.
INDICATIONS FOR PROCEDURE: The patient is an (XX)-year-old female with a history of change in bowel habits. The patient has anemia and underwent colonoscopy, was found to have a mass in the ascending colon with numerous polyps. The patient is here for removal of that.
SPECIMENS: Right colon, partial transverse colon, terminal ileum.
ESTIMATED BLOOD LOSS: 200 mL.
DRAINS: None.
DESCRIPTION OF PROCEDURE:
The patient was brought into the operating room and given general endotracheal anesthesia. The abdomen was prepped and draped in a standard surgical fashion. Incision was carried down to the umbilicus. A Veress needle was introduced into the abdominal cavity and the abdomen was insufflated with CO2 gas. Then, a 12 mm trocar was put into the abdominal cavity. A 10 mm 30-degree scope was passed into the abdominal cavity. The patient was noted to have dense adhesions throughout the entire abdominal cavity, the omentum to the anterior abdominal wall to the right paracolic gutter, into the pelvis. A 5 mm port was placed in the infraumbilical, and using ACE Harmonic scalpel, these adhesions were taken down. Once the adhesions were taken down, there was a floppy transverse colon and there were some adhesions at the level of the splenic flexure, which were taken down and the right colon was mobilized up to the line of Toldt with the use of ACE Harmonic scalpel.
Then, 5 mm and 12 mm ports were removed. The incision was carried down to meet the two ports of the midline approximately 7 cm in length. Through that incision, the remaining adhesions were taken down. The omentum was taken off the anterior abdominal wall. The right colon, ascending colon, transverse colon were then brought up through the incision. The duodenum was identified and mobilized medially. Terminal ileum was transected with a 75 GIA stapler approximately 10 cm proximal to the cecum. The mesentery was taken with the use of the ACE Harmonic scalpel. The ileocolic artery was identified, clamped with Kelly clamps, suture ligated with 0-Vicryl suture x2. Remaining mesentery was taken with the use of ACE Harmonic to level the distal transverse colon. Distal transverse colon was transected with a 75 GIA stapler and the specimen passed off the field, labeled extended right hemicolectomy. It was opened. It was noted to contain numerous polyps, which were large, one highly suspicious for adenocarcinoma. Following that, a functional side-to-side anastomosis was created with 75 GIA stapler followed by closure with a TA 60.
Anastomosis was reinforced with 3-0 Vicryl pop-offs interrupted x2. The corners of the anastomosis were dunked with 3-0 Vicryl interrupted. Bowel was then returned to the abdominal cavity. The abdominal cavity was copiously irrigated with normal saline. There was no evidence of any bleeding. The omentum was draped over the anastomosis and down in the right paracolic gutter. Seprafilm was placed throughout the entire abdominal cavity. The fascia was approximated with #1 PDS in a running fashion and subcutaneous tissue was copiously irrigated. The skin was approximated with staples. The area was clean and dry. A dry sterile dressing was applied. The patient was awoken, extubated and transported to the recovery room in alert, awake and stable condition. All sponge and needle counts were correct at the end of the case.
