Date of Surgery -
Preop Diagnosis -
Postop Diagnosis - same
Surgeon - Dr. Luk / Dr. Tran
Assistant Surgeon -
Anesthesia - General Anesthesia
Blood Loss - Minimal
Complication - None
Findings -
Specimens -
Procedure Performed-
Laparoscopic Left Colectomy
Take down of splenic flexure
Placement of tunnel intra-abdominal drain
Mesenteric resection and excisional removal of Lymph Nodes
Patient comes in with the above diagnosis and was consented for the above procedures. Risks, benefits, and alternatives were discussed with patient, which includes, but are not limited to, postoperative or chronic pain, bleeding, wound infection, hematoma, post-operative abscess, incision disruption, injury to other organs, or need for further procedures or workup. Other complications may include deep vein thrombosis(blood clots), as well as other side effects affecting other organ systems such as the heart or lungs, and in rare circumstances, death as a result of the above complications. The patients understands and agreed that a colostomy for fecal diversion may be needed. The patient understands and agrees to proceed with the proposed procedure.
Descriptions:
The patient was given preop antibiotics and the patient was brought to the operating room. Consent was signed, placed supine on the OR table. Time-out was performed, prepped and draped using standard prep. The patient was placed in lithotomy position.
A 5 mm trocar was placed directly under direct visualization in the patient's right paramedian location. Next, CO2 gas was used to insufflate the abdominal cavity. Next, 2 additional ports were placed. These were a 12mm trocar which was placed in the right lower quadrant and a 5 mm trocar was placed in the epigastric region. They were all placed under direct vision.
I was able to identify the lesion. It is proximal to the rectum and distal sigmoid colon.
I took down the left line of Toldt using the ultrasonic scalpel, from the lateral aspect of the proximal sigmoid colon all the way down to the pelvis.
The splenic flexure had to be taken down to increase the length for anastomosis.
Once the lateral mobilization has been completed, then the mesenteric defect was created below the area of the lesion using ultrasonic scalpel. Next, the GI surgical stapler was used to divide the colon basically at the mid section of the rectum and transected completely across. Next, the Gi stapler was then used to also divide mesentery of the more proximal bowel, working from that point towards the more proximal bowel.
Using the GIA stapler, the mesentery was also divided and lymph notes were removed and or harvested.
Finally, once the diseased segment was mobilized completely, then a small extraction incision was made in the midline abdomen, the incision is about 5 cm. We extracted the mobilized segment of bowel.
Next, I divided the diseased bowel, but before dividing it, I did place the intraluminal stapler anvil in the proximal healthier segment of bowel and then divided the bowel. In this way I was able to secure the stapler anvil in the proximal bowel. The specimen was sent for pathology. I placed the proximal healthy colon section back into the abdominal cavity. I closed the extraction incision. I re-insufflated the abdominal cavity. I then performed anastomosis connecting the rectum to the healthier sigmoid colon under direct vision, this without any problem.
Once the anastomosis was completed, I removed the stapler, I irrigated the abdominal cavity. I flushed across the anastomosis under water to make sure there was no bubbling indicating any leakage, there was none.
Finally, I irrigated the abdominal cavities with copious saline and removed excess fluid. The anastomosis was healthy without any sign of devascularization or tension.
One JP drain was tunneled and positioned intra-abdominally under direct vision.
Hemostasis was completely obtained. Once this was confirmed, I placed the omentum back into position.
At the end of the case, counts were carried out. Instrument, sponge, and needle counts were completed and reported to me as correct.
I removed the trocars. I released the CO2 gas. I changed gloves and gowns and closed all skin incision using skin staples. The patient tolerated the procedure well, transferred to recovery room in stable and satisfactory condition.