DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS:
Colon cancer.
POSTOPERATIVE DIAGNOSIS:
Colon cancer.
PROCEDURE PERFORMED:
Minimally invasive low anterior resection.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, MD
ANESTHESIA: General endotracheal.
SPECIMEN: Rectosigmoid.
ESTIMATED BLOOD LOSS: Minimal.
DRAINS: None.
INDICATIONS FOR PROCEDURE: The patient is a (XX)-year-old female with a history of recent colonoscopic evaluation. The patient was found to have cancer in the sigmoid colon and is here for resection. The patient is also here for total abdominal hysterectomy and bilateral salpingo-oophorectomy.
DESCRIPTION OF PROCEDURE:
The patient was brought to the operating room. After general anesthesia was administered, the patient was placed in lithotomy. Area of the abdomen and perineum was prepped and draped in the standard surgical fashion. Incision was carried down in a Pfannenstiel aspect approximately 7.5 cm in length and further carried down with electrocautery. Carried down to the level of fascia. The fascia was incised. Rectus muscles were split. The abdomen was entered. The remaining wound was opened up with the use of electrocautery. Once the abdomen was opened, Alexis retractor was placed in the abdominal cavity. The area was inspected. There was noted to be very redundant colon and the tumor was noted to be at the level of the sigmoid colon. The uterus, tubes and ovaries were taken out.
Once that was completed, the colon was mobilized along the line of Toldt. The left ureter was identified and mobilized laterally. The colon was then mobilized down to the level of mid rectum. Mesorectum was taken with the use of Kelly clamps and suture ligated with 2-0 Vicryl sutures. The inferior mesenteric artery pedicle was then identified and taken with the use of Kelly clamps. Sutured again with 2-0 Vicryl suture. The mesentery was taken with the use of Kelly clamps and tied with 0 Vicryl ties. The mid descending colon was transected with an auto pursestring device and the 29 anvil was sutured in the proximal colon with the pursestring. The bowel was then transected at the level of the mid rectum with the use of a TA30 and Kocher clamp. Bowel was then passed off the field labeled as rectosigmoid.
Next, a circular-stapled anastomosis was created between the mid descending colon and the mid rectum with the use of a 29 EEA stapler. Anastomosis was inspected by filling the pelvis with fluid, insufflating the rectum. It was noted to be airtight.
Next, the pelvis was copiously irrigated. The liver was inspected. There was no evidence of any metastatic disease noted. The NG tube was noted to be in the stomach. The omentum was replaced in the abdominal cavity. The peritoneum was approximated with 2-0 Vicryl in a running fashion. The fascia was approximated with #1 PDS in a running fashion. Subcutaneous tissue was copiously irrigated and skin was approximated with staples. Area was clean and dry. Dry sterile dressing was applied. The patient was awoken, extubated and transported to the recovery room alert and awake in stable condition. All sponge and instrument counts were correct at the end of the case.
