DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Kidney transplant.
2. Hydroureter and infection of left native kidney.
POSTOPERATIVE DIAGNOSES:
1. Kidney transplant.
2. Hydroureter and infection of left native kidney.
OPERATION PERFORMED: Left retroperitoneal native nephrectomy.
SURGEON: John Doe, MD
CO-SURGEON: Jane Doe, MD
ANESTHESIA: General endotracheal anesthesia.
ESTIMATED BLOOD LOSS: 200 mL.
COMPLICATIONS: None.
DESCRIPTION OF OPERATION: The patient had the procedure after appropriate operative consent was obtained. The patient was taken to the operating room, and after appropriate general endotracheal anesthesia was induced without any hemodynamic compromise or complication, the patient was put in the right decubitus position with the bed in full flexion. Great care was taken to ensure there was excellent padding throughout. At this point in time, the patient’s left flank and abdomen were prepped and draped in the usual sterile fashion using DuraPrep.
A subcostal left flank incision extending to the left upper quadrant was carefully made using a 10 blade. Electrocautery was carefully used to take the incision to the level of the retroperitoneum. The retroperitoneal space was carefully dissected free of surrounding tissue and great care was taken to avoid entry into the peritoneal cavity or the diaphragm itself. The peritoneum was carefully dissected off the retroperitoneum thereby exposing the kidney. A Bookwalter retractor was carefully put into position and the tip of the twelfth rib was carefully excised using Mayo scissors. Hemostasis was maintained using electrocautery.
Circumferential dissection of the kidney was carefully performed. There was noted to be a large amount of inflammatory tissue and frank pus upon entering the retroperitoneal space. The adrenal was spared, and all attachments to the kidney were carefully dissected free aside from the renal artery and renal vein. The ureter was carefully identified and then divided. Due to the large amount of pus that drained from the ureter itself, it was trimmed back to the appropriate position and left open. An Ethicon vascular stapler was carefully used to divide the renal artery and renal vein, and at this point in time, the kidney was carefully removed from the field as a specimen. This was an extremely tedious case, which did require the presence of two attending surgeons secondary to the large size of the kidney as well as the massive amount of infection.
At this point in time, the retroperitoneal space was carefully and repeatedly drained. It was carefully and repeatedly irrigated with antibiotic irrigation, and Penrose drains were carefully put into position. At this point in time, Dr. Jane Doe completed the closure of the incision, and the patient was extubated in the operating room and taken to the postoperative recovery room in stable condition.
