Date of Surgery -
Preop Diagnosis - right colon cancer
Postop Diagnosis -
Surgeon - Dr. Tammy Luk/ Dan Tran
Assistant:
Anesthesia - General anesthesia
Estimated Blood Loss - 100
Complication - none
Findings -
Specimen - Right Colon
Procedure performed -
1) Right Colectomy with Mesenteric resection and excisional removal of Lymph Nodes
2) 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.
A standard midline incision was performed using 10. Scalpel. Dissection down to the fascia using electrocautery. The fascia was opened.
The abdominal retractor was placed for exposure.
Care was taken during the placement of the retractors to to avoid injuring any important structures.
Headlight were used for proper illumination
The right line of tolt was taken down using the electrocautery
The hepatic flexure was also taken down using a combination of the electrocautery and
the ultrasonic scalpel.
Once the lateral attachments were taken down, the mesentery of the right colon was divided.
This was done starting from the terminal ileum going more distally.
Also, a window was created from the mid transverse colon and from there, the mesentery
was divided going proximally until the mesentery of the right colon was divided. The division was
done with a combination of the ultrasonic scalpel and the GI stapler.
Once the mobilization was complete, 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.
Next, we changed gowns and gloves. I re-examined 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 place one JP drain which was tunnelled and placed intra-abdominally next the the anastamosis.
The midline incision was closed using two #1 loop PDS sutures.
The skin incision was closed using skin staples.
The patient tolerated the procedure well, transferred to recovery room in stable and satisfactory condition.