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operative diagnosis: rectal cancer
Postoperative diagnosis: same
Name of procedure: laparoscopic sigmoid loop colostomy, biopsy of peritoneal nodule
Specimen: peritoneal nodule
Findings:
Technique in detail: The patient was brought to the operating room positively identified and placed on the operating table in the supine position with sequential compression devices on his lower extremities. The patient had undergone a slow mechanical bowel preparation as an inpatient. received intravenous antibiotics. He underwent general endotracheal anesthesia without complication. Orogastric tube and Foley catheter were inserted. The patient's arms were wrapped with foam and tucked at his side. A strap was placed across his upper torso. The patient has abdomen was clipped of its hair and prepared and draped in usual fashion.
A critical time-out was performed.
Stoma site had been marked in the left side of the abdomen for a planned left-sided, sigmoid, loop colostomy. A 5 mm Visiport was inserted through a small stab incision in the right upper quadrant with continuous insufflation. Pressures were monitored throughout the procedure. A 2nd 5 mm port was placed in the right lower quadrant. Video laparoscopy revealed no evidence of intra-abdominal injury. A 3rd 5 mm port was placed at the planned stoma site.
Video laparoscopy revealed evidence of a pelvic mass with a dense adherence to the bladder anteriorly. There was no evidence of acute suppuration or peritonitis. There was no intra-abdominal fluid. Peritoneal surfaces were noted to be unremarkable. The liver was inspected and the surface of the liver was noted to be without mass. The patient was placed in steep Trendelenburg position and rotated to the right. The sigmoid colon was mobilized lateral to medial using harmonic scalpel. Care was taken to identify and preserve the left gonadal vessel left ureter. The distal aspect of the sigmoid colon was mobilized to the pelvic brim. A disc of skin was excised at the stoma site and an aperture was created by dissecting over top of the 5 mm port into the peritoneal cavity. The aperture was dilated to 2 fingerbreadths. The sigmoid colon was grasped with an Allis clamp instrument and was brought up through the aperture. The patient's abdominal wall was noted to be approximately 8 cm thick and there was some difficulty in exteriorizing the colon. The bowel was reduced into the peritoneal cavity. An Alexis wound protector was placed at this site and closed with a Kelly clamp. A 5 mm port was placed in this midline suprapubic area. I proceeded with mobilization of the left colon off of Gerota's fascia up to the splenic flexure and the bowel was mobilized well medial to the left ureter. I then proceeded to grasp the colon and brought it up to the level of the aperture site and adequate mobilization was felt to have been achieved. Pneumoperitoneum was relieved in the proximal sigmoid colon was brought up through the aperture. There was a firm small nodule on the mesentery of the exteriorized sigmoid colon. This was excised with scissors and sent to Pathology. This did not appear to be a metastasis following excision. No other nodules were appreciated. A stoma rod was placed underneath this and the rod was secured to the skin using Prolene suture. Care was taken to ensure that there was proper orientation of the mesentery. All ports were removed and the skin incisions closed with Monocryl suture and Dermabond. The stoma was matured as a loop colostomy using interrupted 3-0 Vicryl suture. Stoma appliance was placed over the stoma.
Postoperative diagnosis: same
Name of procedure: laparoscopic sigmoid loop colostomy, biopsy of peritoneal nodule
Specimen: peritoneal nodule
Findings:
- Large pelvic mass adherent to bladder
- Small peritoneal nodule of sigmoid mesentery
- No liver metastases
Technique in detail: The patient was brought to the operating room positively identified and placed on the operating table in the supine position with sequential compression devices on his lower extremities. The patient had undergone a slow mechanical bowel preparation as an inpatient. received intravenous antibiotics. He underwent general endotracheal anesthesia without complication. Orogastric tube and Foley catheter were inserted. The patient's arms were wrapped with foam and tucked at his side. A strap was placed across his upper torso. The patient has abdomen was clipped of its hair and prepared and draped in usual fashion.
A critical time-out was performed.
Stoma site had been marked in the left side of the abdomen for a planned left-sided, sigmoid, loop colostomy. A 5 mm Visiport was inserted through a small stab incision in the right upper quadrant with continuous insufflation. Pressures were monitored throughout the procedure. A 2nd 5 mm port was placed in the right lower quadrant. Video laparoscopy revealed no evidence of intra-abdominal injury. A 3rd 5 mm port was placed at the planned stoma site.
Video laparoscopy revealed evidence of a pelvic mass with a dense adherence to the bladder anteriorly. There was no evidence of acute suppuration or peritonitis. There was no intra-abdominal fluid. Peritoneal surfaces were noted to be unremarkable. The liver was inspected and the surface of the liver was noted to be without mass. The patient was placed in steep Trendelenburg position and rotated to the right. The sigmoid colon was mobilized lateral to medial using harmonic scalpel. Care was taken to identify and preserve the left gonadal vessel left ureter. The distal aspect of the sigmoid colon was mobilized to the pelvic brim. A disc of skin was excised at the stoma site and an aperture was created by dissecting over top of the 5 mm port into the peritoneal cavity. The aperture was dilated to 2 fingerbreadths. The sigmoid colon was grasped with an Allis clamp instrument and was brought up through the aperture. The patient's abdominal wall was noted to be approximately 8 cm thick and there was some difficulty in exteriorizing the colon. The bowel was reduced into the peritoneal cavity. An Alexis wound protector was placed at this site and closed with a Kelly clamp. A 5 mm port was placed in this midline suprapubic area. I proceeded with mobilization of the left colon off of Gerota's fascia up to the splenic flexure and the bowel was mobilized well medial to the left ureter. I then proceeded to grasp the colon and brought it up to the level of the aperture site and adequate mobilization was felt to have been achieved. Pneumoperitoneum was relieved in the proximal sigmoid colon was brought up through the aperture. There was a firm small nodule on the mesentery of the exteriorized sigmoid colon. This was excised with scissors and sent to Pathology. This did not appear to be a metastasis following excision. No other nodules were appreciated. A stoma rod was placed underneath this and the rod was secured to the skin using Prolene suture. Care was taken to ensure that there was proper orientation of the mesentery. All ports were removed and the skin incisions closed with Monocryl suture and Dermabond. The stoma was matured as a loop colostomy using interrupted 3-0 Vicryl suture. Stoma appliance was placed over the stoma.