Date of Surgery -
Preop Diagnosis -
Postop Diagnosis - Same
Surgeon - Dr. Luk / Dr. Tran
Assistant Surgeon -
Anesthesia - General anesthesia
Estimated Blood Loss - Minimal
Complication - none
Findings -
Specimen - Right Colon
Procedure performed -
Laparoscopic Right Colectomy
Mesenteric resection and excisional removal of Lymph Nodes
Placement of tunnel intra-abdominal drain
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, 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 patient understands and agrees to proceed with the proposed procedure.
The Patient was given preoperative antibiotics.
After consent was obtained, the patient was brought to the OR and underwent general anesthesia. The patient was prep and draped in the standard manner.
Timeout was performed and all was in agreement.
Description of Procedure:
The abdominal cavity was entered at the right paramedian location using the trocar under direct vision. This was done using the 5 mm trocar. There was no complication during the entry.
Once we entered the abdominal cavity, CO2 gas was used to insufflate the abdominal cavity. Two additional ports were placed, a 12 mm trocar was placed in the upper left upper quadrant and a 5 mm was placed in the mid pelvis lower abdomen. The procedure began by taking down the white line of Toldt starting from the cecum working towards the hepatic flexure. This was done using the ultransonic scalpel.
Next, The omentum was taken off starting at the mid transverse colon going toward the right side. Next, the hepatic flexure and proximal transverse colon were also freed up laterally using the ultrasonic Scalpel. This completes the lateral mobilization.
Once this was completed, then the mesenteric of the colon was divided starting from the hepatic flexure towards the terminal ileum. The avascular window was identified at the hepatic flexure. From there the GIA stapler was used to divide the mesentery. I proceeded from the hepatic flexure towards the terminal ileum.
Any region of the staple line that shows some bleeding, was reinforce with surgical clips.
Using the GIA stapler, the mesentery was also divided and lymph notes were removed and or harvested.
Once the mesentery of this segment of colon was mobilized, then the segment of interest is completely mobilized.
Next a small extraction incision was made in the mid upper abdomen. The incision was made with skin knife.
The fascia was opened using electrocautery carefully to avoid injuring any structures below. The incision is about 4-5 cm long.
Through this incision, I then extracted the mobilized bowel. I then performed the resection and anastomosis using the the GI stapler.
A side-to-side anastomosis was performed using the stapler. 1st, the 2 segments of bowel to be anastomosed was lined up using 2 silk sutures.
Next, enterotomies were made at both limbs of the bowel to be anastomosed. Finally, the GI staple was used to perform the side-to-side anastomosis.
To seal the hole, and to remove the bowel proximal to the anastomosis, therefore removing the bowel with the specimen of interest, different loads of GIA stapler was used to then crossed divide the bowel distal to the enterotomies.
I removed the right colon including terminal ileum and these were sent for pathology. The anastomosis was then placed back into the abdominal cavity. I then closed the extraction incision fascia using #1 Prolene suture.
Next, we changed gowns and gloves. I re-examined intracorporeally the anastomosis to make sure it was healthy, it was, there was no bleeding. We washed and irrigated the area of dissection and removed any excess fluid. Once we confirmed complete hemostasis and the anastomosis appeared healthy, we performed instrument, needle, and sponge counts. When this was reported to me as correct per the OR staff, I removed the trocars, and released the CO2 gas. All skin incisions closed using staples.
The patient tolerated the procedure well, transferred to recovery room in stable and satisfactory condition.