DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Myelodysplastic syndrome.
POSTOPERATIVE DIAGNOSIS: Myelodysplastic syndrome.
OPERATION PERFORMED: Laparoscopic splenectomy.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, MD
ANESTHESIA: General anesthesia combined with endotracheal tube intubation.
SPECIMEN: Spleen.
COMPLICATIONS: None.
DRAINS: None.
ESTIMATED BLOOD LOSS: Minimal.
INTRAOPERATIVE FINDINGS: During the course of our dissection, as we dissected up through the gastrosplenic ligament, an accessory spleen was identified within the ligament, and this was taken as part of the specimen upon removal of the spleen. No other abdominal pathology was noted.
INDICATIONS FOR OPERATION: This is a (XX)-year-old Hispanic male who was found to have myelodysplastic syndrome that has become refractory to medical management. A splenectomy has been indicated for the management of his myelodysplastic syndrome, and the laparoscopic approach has been elected. All of the risks, benefits, and alternatives of the procedure have been described in detail to the patient. The operative consent has been signed and placed upon the chart. The patient also did receive 2-6 packs of platelets to maximize his platelet function prior to surgical intervention.
DESCRIPTION OF OPERATION: The patient was brought to the operating room, and bilateral lower extremity tourniquets were placed. General anesthesia was induced. An orogastric tube along with Foley catheter was placed. The patient was then positioned in the full lateral position with the left side slightly elevated. All pressure points were then carefully padded.
A small incision was then made in the natural skin line at the left costal margin at the midaxillary line after local had been infiltrated. A 12 mm Optiview trocar was then utilized again to enter into the peritoneal cavity. The abdomen was then insufflated with carbon dioxide to a pressure of 12 to 15 mmHg. The patient tolerated the insufflation well and then a 30-degree laparoscope was inserted. The abdomen was inspected from initial trocar placement, and no injuries were noted. Additional trocars were then inserted along the left costal margin and the left supraumbilical region. The splenic flexure of the colon was then gently displaced inferiorly, and the splenocolic ligament was incised with the ultrasonic Harmonic shears. The colon was then mobilized medially and inferiorly.
Next, the peritoneal folds overlying the short gastric vessels and the short gastric vessels were divided in a similar manner with the ultrasonic shears. The stomach was mobilized medial to maximally expose the hilum of the spleen. The peritoneum overlying the splenic artery and splenic vein was incised. At this time, we then made a skin incision for preparation to insert the laparoscopic disc. A skin incision was made between two of our trocar sites. Bovie electrocautery was utilized to go through the subcutaneous and deep tissues. Hemostasis was achieved, and the peritoneal cavity was then entered. The laparoscopic disc was then placed.
At this time, the surgeon’s left hand was then inserted, and the abdomen was allowed to insufflate again. The patient tolerated the insufflation well. At this time, a posterior was then made with blunt dissection around the splenic vein and the splenic artery. At this time, a 60 mm Ethicon stapling device was then inserted with the vascular load in the splenic and the splenic vein divided. The tail of pancreas was identified and protected from harm.
At this time, the lateral peritoneal attachments and the splenophrenic ligament were then divided with the ultrasonic shears. The spleen was completely mobilized and then it was removed from the peritoneal cavity out through the Lap Disc. During the course of removal of the specimen, it did not fracture, and it was removed in one piece from the surgical fields and inspected for hemostasis. Some mild irrigation was then utilized and suction freed from the abdomen.
At this time, the Lap Disc was removed. The abdomen was obviously desufflated, and trocars were then removed under direct vision. The posterior peritoneum was then closed with a running suture of 0 Vicryl. Anterior fascia within the left subcostal incision was then also reapproximated with the use of a 1-0 Novafil. The subcutaneous tissues were irrigated, siphoned free, and hemostasis was intact. The trocar sites along with the subcostal incisions were then reapproximated with a running subcuticular stitch of 4-0 Monocryl. Sterile dressing was applied.
The patient tolerated the procedure well and was then transported to the recovery room in stable condition. All instruments, sponge, and needle counts were correct at the end of the case.
