DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Right renal mass.
POSTOPERATIVE DIAGNOSIS: Right renal mass.
OPERATION PERFORMED: Right hand-assisted laparoscopic nephrectomy with takedown of abdominal adhesions.
SURGEON: John Doe, MD
ANESTHESIA: General.
ESTIMATED BLOOD LOSS: Less than 100 mL.
SPECIMEN: Right kidney.
COMPLICATIONS: None.
INDICATION FOR OPERATION: The patient is a (XX)-year-old female with right renal mass. Staging workup showed no definitive evidence of disease. After discussion of the potential risks, benefits, complications and alternatives, including but not limited to, bleeding, infection, possible injury to internal structures, possible need for a conversion to open procedure as well as possible need for additional procedures, the patient agreed to proceed.
DESCRIPTION OF OPERATION: The patient was correctly identified and informed consent was obtained. She was brought to the operating room, and once sufficient anesthesia had been rendered, she was prepped and draped in modified flank position.
A 7 cm vertical incision was made in the right paramedian space. The incision was taken down with electrocautery and the peritoneum was then sharply entered. At that point, the GelPort device was placed in standard fashion. A trocar was then placed through the GelPort and insufflation was administered through the trocar. A 30 degree laparoscope was passed through the trocar and immediately visualized were some abdominal wall adhesions, presumably secondary to her previous open appendectomy. These were bypassed and two other 12 mm trocars were placed, one in the subcostal area and one in between the GelPort and the subcostal trocar. The laparoscope was moved to one of the secondary 12 mm ports and the hand was then placed through the GelPort. Using Harmonic scalpel, adhesiolysis of the abdominal adhesions was carefully performed to allow the hand unrestricted access to the surgical bed. Once the adhesions were taken down, the colon was then reflected off the surface of the kidney using blunt dissection and Harmonic scalpel. In similar fashion, the duodenum was kocherized medially using Harmonic scalpel. At that point, a laparoscopic Kittner was used to gently probe the area of the expected renal hilum. This did result eventually in visualization of what appeared to be renal artery and vein. These were stapled using a laparoscopic Endo-GIA stapler. Two loads were used. At this point, the Harmonic scalpel was used to dissect around the lower pole of the kidney. The ureter was encountered which was double clipped and sharply divided in between the clips. Harmonic scalpel dissection was carried up past the hilum and around the upper pole. Lateral attachments were taken down bluntly and with the Harmonic scalpel. In this fashion, the entire kidney was freed. It was then removed through the GelPort opening. The insufflation pressure was brought down to 5 mmHg. There did not seem to be any active bleeding in the surgical bed. Some Surgicel was placed in the area of the hilum.
At that point, the trocars were removed under visualization with no evidence of bleeding. The GelPort was removed. The GelPort hand incision was closed using figure-of-eight 0 Vicryl sutures. The wound was then irrigated and the skin was closed with surgical staples. The two 12 mm trocar sites were also closed with surgical staples. Anesthesia was reversed. The patient tolerated the procedure well.
