Here is the OP NOTE if it would help anyone to assist me please:
OPERATIVE TECHNIQUE:
After the patient was identified in the holding area, proper consent was obtained, the patient was taken back to operative suite, placed on the supine position on the operative table. A time out was performed to ensure proper patient and procedure. After satisfactory induction of general anesthesia, The patient was formally sterilely prepped and draped. Ancef administered. An official time-out was performed. Bilateral SCDs were placed. General anesthesia was then induced. The abdomen was then prepped and draped in usual sterile fashion. Using 0.25% Marcaine all proposed incision sites were anesthetized prior to making incision. Access was obtained via a optiview 5 mm LUQ trochar that was replaced later with 8 mm trochar and 3 Secondary trocars were placed one in the umbilical region, one in the LUQ and one in RUQ area with assisting port in between the umbilical and RUQ one. Nathanson liver retractor was placed in the epigastric area to retract the left lobe of the liver. The patient was then placed in reverse Trendelenburg position and rolled to the left. The robot was brought in and docked. Initial instrument were placed and I un-scrubbed for console dissection. Attention was then turned towards the right upper quadrant and the hepatogastric ligament was approached and taken down using vessel sealer until we identified the left gastric pedicle that was dissected meticulously down to the origin of the left gastric artery from the celiac trunk, at this point we encircled the pedicle with penrose drain and using the assisting port my assistant retract the left gastric pedicle downward and to the right to expose the supraceliac area. The muscle fibers of the right crus of the diaphragm was taken down using vessel sealer until we exposed the supraceliac aorta, all the preaortic tissues was taken down with sharp and blunt dissection using vessel sealer at least 5 cm proximal to the celiac trunk. At this point all the celiac trunk branched were identified (the left gastric, common hepatic and the splenic artery). Then, our attention was directed to take down and release all neuromuscular fibers around the celiac trunk to complete the median arcuate ligament release and celiac neurolysis. Hemostasis was achieved and irrigation using warm saline was performed. Then the penrose drain was removed and surgicel powder was placed around the celiac trunk area. Hemostasis was achieved and the area looked dry.
Then the robot was undocked and the liver retractor was removed under direct visualization, the fascial defect of the 12 mm port site was closed with # 0 vicryl using Cart-Thompson. And all ports removed with no issues. Subcutaneous tissue for all the incisions were irrigated and dried. All incisions were closed using 4-0 Monocryl in simple subcuticular fashion. The abdomen was cleaned and dried and Dermabond was placed on all the incisions. The patient tolerated the procedure well. There were no complications. All needle, instrument, and sponge counts were correct per nursing staff x2. The patient was awakened, extubated, and transferred to the recovery room in stable condition.
