NAME OF PROCEDURE: Laparoscopic appendectomy.
PREOPERATIVE DIAGNOSIS: Acute appendicitis.
POSTOPERATIVE DIAGNOSIS: Acute appendicitis.
SURGEON: John Doe, MD
ANESTHESIA: General endotracheal anesthesia.
COMPLICATIONS: None.
FINDINGS: The appendix is acutely inflamed with no evidence of necrosis or perforation. There is no abscess or purulence.
INDICATION FOR PROCEDURE: The patient is a (XX)-year-old gentleman who presented to the emergency department yesterday evening with worsening right lower quadrant pain. A CT scan of the abdomen and pelvis was performed, which was concerning for an acute appendicitis.
Therefore, the patient was admitted to the surgical service, kept n.p.o., given IV fluids and IV antibiotics. He was taken to the operating room today for laparoscopic appendectomy.
The risks and benefits of laparoscopic appendectomy were described in great detail to the patient who expressed understanding and agreed to proceed.
DESCRIPTION OF PROCEDURE: After informed consent was obtained, the patient was taken to the operating room and placed in supine position for the laparoscopic appendectomy. General endotracheal anesthesia was induced, and the patient tolerated this well.
He was prepped and draped in the usual sterile manner and a time-out was performed. A supraumbilical incision was then made, and blunt dissection was carried down to the fascia.
A stab incision was made at the fascia and a Kelly was used to enter the peritoneum. Two stay sutures were placed at the superior and inferior portion of this fascial wound, and a Hasson trocar was inserted and secured in place with these sutures.
Pneumoperitoneum was achieved up to 15 mmHg, which the patient tolerated well. A laparoscope was inserted and confirmation was made that we were in fact inside the abdomen.
Under direct visualization, 2 more trocars were inserted. These were 5 mm trocars, 1 in the suprapubic and 1 in the left lower quadrant.
Attention was then turned to the right lower quadrant where the appendix was situated posterior to some adhesions to the anterior abdominal wall. These were taken down bluntly.
The appendix was then grasped and dissected both with blunt dissection and electrocautery. A window was made in the mesoappendix, and a white load stapler was then used to staple off the mesoappendix.
A blue load stapler was then used to staple off the appendix at its base. This was done with adequate hemostasis.
The appendix was then removed with an EndoCatch bag. After the abdomen was inspected and hemostasis was satisfactory, all excess liquid was suctioned out.
There was no need for any further irrigation. Therefore, the patient’s abdomen was deflated, and all trocars were removed.
Attention was then turned to the Hasson trocar site and the supraumbilical incision site where a figure-of-eight suture was then placed with some 2-0 Vicryl suture to further close the fascia.
All skin incisions were then closed with 4-0 Monocryl sutures in interrupted fashion and the skin was then dressed with Dermaflex x2. The skin was cleaned with a wet and then followed by a dry, and the patient was extubated and transferred to the PACU in good condition.
