Copy of op report
This is a copy of the op report for the cholecystectomy and the bronchoscopy.
PREOPERATIVE DIAGNOSIS: Acalculous cholecystitis.
POSTOPERATIVE DIAGNOSES:
1. Acalculous cholecystitis.
2. Difficult airway.
PROCEDURE:
1. Flexible bronchoscopy with placement of airway.
2. Laparoscopic cholecystectomy with an intraoperative cholangiogram.
SURGEON:
ASSISTANT
ANESTHESIA: General endotracheal.
OPERATIVE PROCEDURE: After satisfactory IV sedation was obtained, anesthesia attempted to put an airway in using a video laryngoscope. The vocal cords were easily visualized, however, the patient’s neck angle was extremely tight, and even with adjustable instruments, they were not able to safely place the airway. Therefore, the patient was allowed to awaken. With him awake, I placed a bronchoscope in the right naris, advanced it to the carina, and over the bronchoscope slid a #7 nasotracheal tube. The cuff was insufflated and excellent oxygenation was achieved.
Once general anesthesia was achieved, the patient’s abdomen was prepped and draped in the usual fashion. A Visi-Port was introduced in the right upper quadrant, and under direct visualization, a 5 mm port was placed at the umbilicus. 2 mm ports were introduced in the right upper quadrant. The cystic duct was dissected out and a negative intraoperative cholangiogram was obtained. The cystic duct and cystic artery were doubly hemoclipped and divided. The gallbladder was dissected from the gallbladder fossa with electrocautery dissection and removed through the subxiphoid position. The subxiphoid fascia was closed with 2-0 PDS sutures. All air and all instruments were then removed. The wounds were injected with Marcaine and the incisions were closed with 4-0 Prolene. The patient tolerated the procedure well