kajalgaonkar16
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How do you understand that a procedure is Laparoscopic when the word laparoscopy is not mentioned in the medical notes?
For eg;
After informed consent was obtained, the patient
was taken to the OR where general endotracheal anesthesia was administered.
Patient was prepped and draped in a normal sterile fashion in a dorsal
lithotomy position. Sponge stick was placed into the vagina and Foley
catheter was placed. A 12-mm incision was made superior to the umbilicus and
a Veress needle was inserted into the abdomen. Appropriate placement was
confirmed with saline injection, aspiration and drop test. The abdomen was
insufflated with an opening pressure of 3. A 12-mm trocar was placed through
this incision and camera was used to survey the abdominal cavity. An 8-mm
robotic trocar was placed in the left upper quadrant. An EnSeal device was
used to take down omental adhesions to the anterior abdominal wall. Once this
had been done, the patient was placed in steep Trendelenburg position.
Another 8-mm robotic trocar was placed in the far right lateral position to
the umbilicus and a 12-mm accessory trocar was placed in the right upper
quadrant. The robot was then docked and the operating surgeon went to the
console with fenestrated graspers in the left arm and monopolar scissors in
the right. The right fallopian tube and ovary were grasped and EnSeal device
was used to come across the right infundibulopelvic ligament. A careful
dissection was performed with monopolar scissors and EnSeal device to remove
the fallopian tube and ovary from the right pelvic sidewall. Once the
specimen had been completely freed, it was placed in an Endopouch and removed
from the abdomen. Attention was then turned to the left side of the pelvis.
Initially, the left fallopian tube and ovary could not be seen at all, so a
careful dissection with monopolar scissors was started at freeing the bowel
from the left pelvic sidewall and from the adnexa. Once all the bowel had
been freed and removed, the EnSeal device was used to come across the left
infundibulopelvic ligament. A combination of monopolar scissors and EnSeal
device were used to carefully dissect away the left fallopian tube and ovary
from the left pelvic sidewall. Once the specimen was freed, it was placed in
an Endopouch. The cyst was not ruptured within the abdominal cavity. The
pelvis was suction irrigated and Arista was placed over both areas of
dissection. The instruments were then removed. The robot was undocked and
the patient was taken out of Trendelenburg position. The CO2 gas was allowed
to escape from the abdomen. The accessory trocar was removed at the same time
as the Endopouch was brought to the level of the skin. The cyst was ruptured
within the Endopouch and the fluid was suction irrigated out. The specimen
was then able to be removed from the abdomen. All the trocars were removed
and the two 12-mm trocar sites were closed with a single deep stitch of 0
Vicryl. All trocar sites were closed in a subcuticular fashion with 3-0
Monocryl, then sealed with Dermabond. A cystoscopy was then performed and the
bladder was noted to be normal and intact with vigorous efflux of urine
through both ureters. The procedure was then terminated. All counts were
recorded as correct. The patient was extubated and went to the recovery room
in stable condition.
For eg;
After informed consent was obtained, the patient
was taken to the OR where general endotracheal anesthesia was administered.
Patient was prepped and draped in a normal sterile fashion in a dorsal
lithotomy position. Sponge stick was placed into the vagina and Foley
catheter was placed. A 12-mm incision was made superior to the umbilicus and
a Veress needle was inserted into the abdomen. Appropriate placement was
confirmed with saline injection, aspiration and drop test. The abdomen was
insufflated with an opening pressure of 3. A 12-mm trocar was placed through
this incision and camera was used to survey the abdominal cavity. An 8-mm
robotic trocar was placed in the left upper quadrant. An EnSeal device was
used to take down omental adhesions to the anterior abdominal wall. Once this
had been done, the patient was placed in steep Trendelenburg position.
Another 8-mm robotic trocar was placed in the far right lateral position to
the umbilicus and a 12-mm accessory trocar was placed in the right upper
quadrant. The robot was then docked and the operating surgeon went to the
console with fenestrated graspers in the left arm and monopolar scissors in
the right. The right fallopian tube and ovary were grasped and EnSeal device
was used to come across the right infundibulopelvic ligament. A careful
dissection was performed with monopolar scissors and EnSeal device to remove
the fallopian tube and ovary from the right pelvic sidewall. Once the
specimen had been completely freed, it was placed in an Endopouch and removed
from the abdomen. Attention was then turned to the left side of the pelvis.
Initially, the left fallopian tube and ovary could not be seen at all, so a
careful dissection with monopolar scissors was started at freeing the bowel
from the left pelvic sidewall and from the adnexa. Once all the bowel had
been freed and removed, the EnSeal device was used to come across the left
infundibulopelvic ligament. A combination of monopolar scissors and EnSeal
device were used to carefully dissect away the left fallopian tube and ovary
from the left pelvic sidewall. Once the specimen was freed, it was placed in
an Endopouch. The cyst was not ruptured within the abdominal cavity. The
pelvis was suction irrigated and Arista was placed over both areas of
dissection. The instruments were then removed. The robot was undocked and
the patient was taken out of Trendelenburg position. The CO2 gas was allowed
to escape from the abdomen. The accessory trocar was removed at the same time
as the Endopouch was brought to the level of the skin. The cyst was ruptured
within the Endopouch and the fluid was suction irrigated out. The specimen
was then able to be removed from the abdomen. All the trocars were removed
and the two 12-mm trocar sites were closed with a single deep stitch of 0
Vicryl. All trocar sites were closed in a subcuticular fashion with 3-0
Monocryl, then sealed with Dermabond. A cystoscopy was then performed and the
bladder was noted to be normal and intact with vigorous efflux of urine
through both ureters. The procedure was then terminated. All counts were
recorded as correct. The patient was extubated and went to the recovery room
in stable condition.