I am looking for some direction on the following:
INDICATION: 53 F with history of endometrial cancer s/p chemo and radiation with a lower abdominal wall recurrence of tumor. The mass was anterior to the bladder, anterior to the space of Retzius and adjacent to the bladder wall. I had evaluated the patient preop cystoscopically and there was no gross invasion of the tumor into the bladder wall. I discussed with the patient possible need for partial cystectomy vs dissection of the tumor off the bladder serosa pending the intraop findings. I had an extensive discussion re risks/benefits/alternatives of the procedure and the patient elected to proceed with the aforementioned procedure.
OPERATIVE FINDINGS:
1. Dissection of the bladder off of the tumor, surgical plane between the tumor and bladder did not demonstrate any tumor infiltration into the bladder wall
2. Opening of the pre-vesical space
3. Frozen bladder margin negative for tumor
DESCRIPTION OF OPERATION:
As above, pt was in the dorsal lithotomy position with the robot docked to the pelvis. DrX had evaluated the abdomen for other signs of disease. The anterior abdominal wall tumor was palpable and the bulk of the tissue was anterior to the bladder requiring dissection of the prevesical space. The bladder was gently filled with air. I then started dissection of the tumor from the prevesical space, taking care to develop the tissue between the tumor and bladder serosa without entry into either. The tumor was entirely in the anterior abdominal wall and did not appear to enter the bladder tissue. The dissection continued caudally to pubic bone, and this was dissected in preparation for placement of the abdominal mesh. The air in the bladder was released and there was no entry into the bladder wall.,
Next, I scrubbed in to assist DrX with the dissection of the anterior abdominal wall, which is dictated separately. At this point, the case was turned over to DrX.
Thank you!
INDICATION: 53 F with history of endometrial cancer s/p chemo and radiation with a lower abdominal wall recurrence of tumor. The mass was anterior to the bladder, anterior to the space of Retzius and adjacent to the bladder wall. I had evaluated the patient preop cystoscopically and there was no gross invasion of the tumor into the bladder wall. I discussed with the patient possible need for partial cystectomy vs dissection of the tumor off the bladder serosa pending the intraop findings. I had an extensive discussion re risks/benefits/alternatives of the procedure and the patient elected to proceed with the aforementioned procedure.
OPERATIVE FINDINGS:
1. Dissection of the bladder off of the tumor, surgical plane between the tumor and bladder did not demonstrate any tumor infiltration into the bladder wall
2. Opening of the pre-vesical space
3. Frozen bladder margin negative for tumor
DESCRIPTION OF OPERATION:
As above, pt was in the dorsal lithotomy position with the robot docked to the pelvis. DrX had evaluated the abdomen for other signs of disease. The anterior abdominal wall tumor was palpable and the bulk of the tissue was anterior to the bladder requiring dissection of the prevesical space. The bladder was gently filled with air. I then started dissection of the tumor from the prevesical space, taking care to develop the tissue between the tumor and bladder serosa without entry into either. The tumor was entirely in the anterior abdominal wall and did not appear to enter the bladder tissue. The dissection continued caudally to pubic bone, and this was dissected in preparation for placement of the abdominal mesh. The air in the bladder was released and there was no entry into the bladder wall.,
Next, I scrubbed in to assist DrX with the dissection of the anterior abdominal wall, which is dictated separately. At this point, the case was turned over to DrX.
Thank you!