Pedigo07
New
DX: Post op bleeding
Procedure: Exploratory Laparoscopy with irrigation and removal of blood clots, fulguration of areas
Had laparoscopic nephrectomy the day before.
Procedue: The patient was taken to the OR. Anesthetic was induced and pt was placed. Previous trocar sites were opened. A 12 milimeter port was placed at the original port that was just to the right of the umbilicus. Also a 12 milimeter port was placed at where the robotic 8 milimeter port had been and also the other 8 millimeter robotic port was placed at the 12 millimeter port. Prior to that, a safe ballon 12 millimeter port was placed where the laparoscope was used. The other ports were placed under direct vision with the laparoscope. Also a 5 millimeter port was placed in the same placement where a 5 millimeter port had been placed before. This would be used to retract the liver. On looking in there was a good bit of hematoma with clot located in the right flank. Using a 10 millimeter suction irrigator, the majority of this was removed. The bipolar grasper was used and helped to retract mesentery medially to expose to the staple lines that were from the removal of the kidney. There was no active arterial bleeding seen. The adrenal bed was investigated and several clips were placed, however, no active bleed was noted. The area was suctioned free. There was also some potential clots down in where the lower pole of the kidney was disectted. This was fulgurated with bipolar cautery. Any areas of bleeding seemed to be just a slight ooze all over was then bipolar cauterized. Following this, the pressure in the abdomen was decreased to 8 centimeters of pressure. We wanted to give a good bit of time to make sure that the bleeding would not recur. Everything was inspected and no bleeding. Thrombin 5000 units was instilled to the area and also Surgical three different pieces were placed in the area. The procedure was tolerated well.
Sorry so long...I did not know what all would be needed...I am use to the cystos and stuff but my doctors have just started these.
Thanks for all of your help ahead of time!