DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Left renal cell carcinoma.
POSTOPERATIVE DIAGNOSIS: Left renal cell carcinoma.
OPERATION PERFORMED: Hand-assisted laparoscopic left radical nephrectomy.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, MD
ANESTHESIA: General plus 20 mL of 0.5% Marcaine.
BLOOD LOSS: 50 mL, per anesthesia.
COMPLICATIONS: None.
DESCRIPTION OF OPERATION: The patient was placed initially in the supine position. A Foley catheter was inserted. SCD hose was applied. The patient was then rotated up in about a 60 degree left flank up position. The table was flexed. An axillary roll was placed under his right axilla. Pillows were placed between his legs. The patient was then taped onto the table. Sandbags were placed behind his back. The patient was then prepped and draped in the usual manner for surgery.
An incision was made just at the level of his umbilicus and carried down towards the feet for a total of 8 cm. It was carried down into his abdominal cavity. A 12 mm trocar was then placed just below the anterior iliac crest and just off the midline. A second trocar was placed lateral, almost at the level of his anterior iliac crest. These were both placed with a hand in the abdominal cavity. Ports were then placed. A Gelport was then placed in the abdominal wound. The abdomen was insufflated with CO2.
An incision was made along the line of Toldt and the colon was reflected medially. The area between the anterior layer of Gerota’s and posterior peritoneum was readily identified and separated out very nicely. The lateral margin of the kidney was freed up slightly. The inferior margin of the kidney was then freed up basically with blunt dissection. The ureter was identified but not transected at this point. The incision was then carried up along the medial aspect of the kidney until the artery was identified. It was separated from the surrounding tissues. The renal vein was identified just above this, and it was also separated out from the surrounding tissues. There was a small branch of the renal vein, which goes down along the renal artery and then swings around the base of it, probably a lumbar vessel.
An attempt was made to pass the staple gun across the artery, but there was not quite enough room to do so. The artery was clipped with large Ligaclips x2 on the proximal side and once on the distal side of the artery. The staple gun was then passed across the left renal vein and fired and transected. There was good hemostasis. The artery was then stapled with a staple gun. There was good stapling of the artery and there was no bleeding. The kidney was then fully mobilized on its lateral superior margin. Predominately with blunt dissection, small vessels were fulgurated. The adrenal gland was identified on its inferior margin and left in place. Specimen was then freed up. On the inferior aspect, the ureter was transected across Ligaclips. The pressure in the abdomen was then decreased from 15 cm to 5 cm of pressure.
Reinspection of the wound demonstrated no evidence of any apparent bleeding. The ports were then removed. The kidney was removed out through the hand port and the GelPort was also removed. The 12 and 10 mm lap ports were oversewn with a figure-of-eight 0 Vicryl suture. The fascia was closed with a running 0 Vicryl suture. Before closure of the vessels, a total of 20 mL of 0.5% Marcaine was injected in all of the wounds. The skin was then approximated with skin clips. The patient tolerated the procedure well. Blood loss per anesthesia was 50 mL, and no complications were encountered during the procedure.
