DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Hydrocephalus.
POSTOPERATIVE DIAGNOSIS: Hydrocephalus.
OPERATION PERFORMED: Ventriculoperitoneal shunt.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, MD
COMPLICATIONS: None.
SPECIMENS: None.
INDICATION FOR OPERATION: The patient is a (XX)-year-old gentleman who has a history of a severe subarachnoid, intraventricular hemorrhage, who was treated and had a great recovery. The ventriculostomy, however, has not been able to be removed, and so before sending the patient to rehab, the decision was made to proceed with ventriculoperitoneal catheter. The patient understands the risks and benefits of the procedure and particularly the risks, which mainly consist of stroke, hematoma, reoperation and infection and signed the consent.
DESCRIPTION OF OPERATION: The patient was intubated and placed in a supine position with his head slightly tilted to the right. The previous left frontal incision, where the previous ventricular catheter was placed, was prepped along with the posterior parietal area, the left side of the neck, and the abdomen. These areas were then draped in a sterile fashion.
First, an incision was made at the level of the frontal area where a bur hole was made with the Midas-Rex. Then, the peritoneal catheter was passed from the frontal area to the posterior parietal area and then to the right abdominal area. The peritoneal catheter was then connected to a programmable valve set at 120 mm of water. After that, the dura was opened and then a ventricular catheter was inserted into the ventricle at a depth of 6 cm. Then, the ventricular catheter was connected to the programmable valve after verification of flow. After all connections were made, the peritoneal catheter was checked for spinal fluid flow. Then, the abdominal wall was dissected in layers, and the peritoneal cavity was opened and the peritoneal catheter was inserted into the peritoneal cavity.
Then, all the incisions were irrigated with antibiotic solution. The frontal incision was closed with 3-0 Vicryl and 3-0 nylon. The small posterior parietal incision was closed with staples and the abdominal wall incision was closed with 2-0 Vicryl, 3-0 Vicryl and Dermabond for the skin.
Sample #2
DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Hydrocephalus.
POSTOPERATIVE DIAGNOSIS: Hydrocephalus.
OPERATION PERFORMED: Right frontal ventriculoperitoneal shunt insertion.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, MD
ANESTHESIA: General with endotracheal intubation.
ESTIMATED BLOOD LOSS: Less than 25 mL.
COMPLICATIONS: None.
DESCRIPTION OF OPERATION: The patient was brought to the operating room where she was induced under general anesthesia and intubated. She was placed in the supine position with the head turned slightly to the left, resting on a donut headrest. The site around the previous ventriculostomy was shaved, prepped, and draped in the usual sterile fashion extending down over the neck and chest to the right upper quadrant of the abdomen.
A curvilinear incision was made around the planned bur hole site in the scalp with #10 blade and Bovie electrocautery. The flap was held open with self-retaining retractor. Particular attention was paid to leaving periosteal tissue on the bone for tack-down sutures. The previous ventriculostomy catheter was identified and left in place. In the abdomen, a linear incision was made three fingerbreadths below the right costal margin with a #10 blade. Bovie electrocautery was used to divide the subdermal fat and the fascia. The muscle fibers were split, and the deep fascia was opened with Church scissors. The peritoneum was alternately grasped and released, ensuring no bowel entrapment and then opened with the Church scissors.
Intraperitoneal exposure was confirmed by placement of a Penfield 4 dissector without resistance. A pursestring suture with 3-0 silk was placed around the peritoneal opening. The tunneling catheter was then passed under the subcutaneous tissues from the abdomen up to the neck where a jump incision was made. The shunt tunneler was irrigated with antibiotic irrigation. The distal catheter was passed through from this location and the tunneler removed. A new tunneler was then passed from the scalp to the jump incision of the neck and the distal tubing was then passed all the way up to the scalp incision in this manner. The programmable valve and the distal tubing were both primed with lactated Ringer’s and then attached, being secured with a 3-0 silk tie.
At this point, the ventriculostomy catheter was removed. A new ventricular catheter was then passed through the previous tract without a stylet with CSF coming out under pressure at a depth of 5 cm from the outer table. It was secured at 6 cm from the outer table and cut to length. It was attached to the proximal end of the valve and secured with the 3-0 silk tie. The distal tubing was pulled from the abdomen as the valve was then tunneled under the scalp away from the incision. Normal spontaneous antegrade flow was confirmed at the distal tip of the catheter. At this point, the distal catheter was cut to length and placed into the peritoneum. The pursestring was then secured. The ventricular catheter was secured to the periosteum over an elbow connector with a 3-0 silk stitch.
The galea was then closed with 2-0 Vicryl sutures and the skin closed with skin staples. The abdominal wound was closed with 3-0 Vicryl sutures in the deep fascia and in the subdermal layer, followed by a 4-0 running Monocryl stitch in the skin. Both wounds were then dressed with a Telfa dressing, sponge, and paper tape. The patient was then awakened from anesthesia and extubated without difficulty. The patient was taken to the PACU in stable condition.
