Septoplasty Medical Transcription Transcribed Operative Sample Report

PREOPERATIVE DIAGNOSES:

1.  Nasal obstruction.

2.  Septal deviation.

POSTOPERATIVE DIAGNOSES:

1.  Nasal obstruction.

2.  Septal deviation.

OPERATION PERFORMED:  Septoplasty.

SURGEON:  John Doe, MD

ANESTHESIA:  General anesthesia.

COMPLICATIONS:  None.

ESTIMATED BLOOD LOSS:  Less than 20 mL.

INDICATIONS FOR OPERATION:  This is a (XX)-year-old woman with a remote history of nasal trauma, who now presents for left-sided nasal obstruction.  The patient was found on physical examination to have a deviated septum.  It was felt that the patient would benefit from straightening the septum to increase ease of breathing, and the patient was taken to the operating room to correct this issue.

DETAILS OF PROCEDURE:  After informed consent was obtained, the patient was brought to the operating room and placed on the table in the supine position.  Once a suitable plane of anesthesia was obtained, the patient was endotracheally intubated by anesthesia personnel.  Afrin-soaked nasal pledgets were instilled into the nasal cavity bilaterally.  After decongestion, 1% lidocaine with 1:100,000 epinephrine was injected into the left septum to aid with hydrodissection as well as hemostasis.  Local was injected into the right nasal septum at the level of the bony-cartilaginous junction.

Next, the patient was prepped and draped in the standard fashion. A hemitransfixion incision was made in the left anterior nasal vestibule.  Care was taken not to injure the nasal sill.  Using a combination of sharp and blunt dissection, a mucoperichondrial flap was elevated on the left side beyond the deviated cartilaginous septum and just posterior to the bony-cartilaginous junction. The cartilaginous septum was found to be convex to the left side just anterior to the bony-cartilaginous junction. The septal cartilage was then disarticulated from the perpendicular plate of the ethmoid and vomer, and a mucoperichondrial flap was elevated on the right side, fully exposing the bony septum.

Care was taken to get all the mucosa off of the bony septum before removing the bony septum with rongeur forceps. After removal of the perpendicular plate of the ethmoid and some tissue of the vomer, the nasal cavity was reinspected and the septal deviation was corrected. Flaps were inspected and the right-sided flap was intact. On the left side, there was a small rent less than 2 mm on the inferior aspect of the mucoperichondrial flap. The bilateral nasal cavity passages were adequately opened, and the remaining cartilaginous septum was found to be left in the midline.

The anterior hemitransfixion incision was then closed with interrupted 4-0 chromic, and a quilting suture was placed through the flaps to lessen the dead space with 4-0 plain gut. At this point Afrin-soaked nasal pledgets were placed in the bilateral nasal cavities. The nasopharynx was suctioned of any blood, and care was turned over to Anesthesia for extubation. The patient was successfully extubated in the operating room and stable upon transfer to the postanesthesia care unit. Afrin pledgets were removed in the postanesthesia care unit prior to discharge.

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Cryosurgical Ablation and Transrectal Ultrasound of the Prostate with Cystoscopy Medical Transcription Sample Report

PREOPERATIVE DIAGNOSIS:  Prostate cancer.

POSTOPERATIVE DIAGNOSES:  Prostate cancer and hematuria.

OPERATIONS PERFORMED:

1.  Cryosurgical ablation of the prostate.

2.  Transrectal ultrasound of prostate for volume determination.

3.  Cystoscopy with insertion of urethral warmer device.

SURGEON:  John Doe, MD

ANESTHESIA:  General.

ANESTHESIOLOGIST:  Jane Doe, MD

ESTIMATED BLOOD LOSS:  Less than 50 mL.

DRAINS:  A 16-French Foley catheter.

SPECIMENS:  None.

INDICATIONS:  This is a (XX)-year-old male who was found to have prostate cancer with a Gleason score of 3 + 4 = 7, which was found bilaterally at the apex, mid portion, and base. All sites were involved and 9 of 12 cores were positive for cancer. The maximum size of carcinoma was 8 mm; 15% of the tissue was involved. The Gleason score was 3 + 4 = 7 with 30% to 40% Gleason grade 4. The patient's PSA level was elevated at 7.32. Rectal exam revealed a nodule at the right base extending towards the seminal vesicle. This patient has decided to undergo cryosurgical ablation as treatment for curative intent of his prostate cancer.

DESCRIPTION OF PROCEDURE:  The patient was brought to the operating room and general anesthesia was given. He was then placed in lithotomy position and shaved over the perineum and also over the suprapubic area, in anticipation of possible suprapubic cystostomy tube placement. The patient was prepped in standard fashion and sterile drapes were applied. A transrectal ultrasound probe was then inserted into the rectum. Transrectal ultrasound of the prostate was then performed for volume determination. Measurements were made of the prostate, yielding a height of 47 mm, width of 36 mm, and length of 44 mm. The calculated volume is acceptable for cryosurgical ablation. The patient was also determined not to need a suprapubic catheter for postoperative drainage because of his relatively small prostate size. The prostate was carefully mapped and plans were made to insert 7 IceRod cryotherapy needles by ultrasound guidance for the cryosurgical ablation. It should be noted that during the transrectal ultrasound procedure, aerated KY jelly was injected into the urethra, so that the urethra could be visualized by ultrasound.

Cryotherapy needles were then placed, beginning by placing two needles in the anterior row on channel 1, two needles were then placed in the middle row on channel 2, two lateral needles were placed in the posterior row with the right needle on channel 3 and the left needle on channel 4, a midline needle was placed in the posterior row on channel 5. A temperature probe labeled T1 was placed into the Denonvilliers fascia at the level of the insertion of the rectourethralis muscle. A T2 temperature probe was placed at the level of the external urethral sphincter. Each needle tip was advanced until the tip reached the proper location, as confirmed by both transverse and sagittal ultrasound views.

Cystoscopy was then performed with the flexible cystoscope to confirm that no needles passed through the prostate into the bladder and also to confirm that no needles had penetrated the prostatic urethra. At the end of the cystoscopic procedure, a Super Stiff guidewire was passed through the scope and left in the bladder. The scope was then back-loaded off the wire. The urethral warmer device was placed over the guidewire into the bladder. This was connected to continuous warm irrigating solution, which was kept at 43 degrees throughout the rest of the case.

Cryosurgical ablation of the prostate was then performed using the Galil SeedNet argon-based cryotherapy unit. The needles were activated sequentially from the anterior row to the middle row to the posterior row, and the progress of the cryotherapy was followed by ultrasound and by monitoring the thermal sensors. After the first freezing cycle, the Denonvilliers fascia reached a minimal temperature of -14 degrees centigrade. The external sphincter temperature probe reached a temperature of 1 degree centigrade. An active thaw cycle was then performed. When all areas of the prostate became isoechoic and temperature in all thermal sensors had reached above 30 degrees centigrade, the second freezing cycle was commenced. Once again, the prostate was completely frozen and the freezing was followed all the way down to the level of Denonvilliers fascia. The T1 probe was noted to reach a temperature of -9 degrees centigrade. The T2 probe in the external urethral sphincter reached a low temperature of 4 degrees centigrade.

Active thaw was then performed and all temperature and cryotherapy needles were removed. A passive thaw cycle was then continued for an additional 20 minutes. At that point, the urethral warming device was removed, a 16-French Foley catheter was passed through the urethra into the bladder and 10 mL was inflated into the catheter balloon. The catheter was connected to gravity drainage. Rectal exam confirmed that the rectal mucosa was intact and freely mobile. Compression was applied through a surgical towel onto the perineum until bleeding had stopped at the needle puncture sites. An ABD pad with triple antibiotic ointment was then placed over this area and secured with paper tape. The patient tolerated the procedure well and was taken to the recovery room in stable condition.

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Plastic Surgery Medical Transcription Operative Sample Report

PREOPERATIVE DIAGNOSES:

1.  Pannus.

2.  Excess skin of arms.

POSTOPERATIVE DIAGNOSES:

1.  Pannus.

2.  Excess skin of arms.

PROCEDURES PERFORMED:

1.  Panniculectomy.

2.  Cosmetic brachioplasty.

SURGEON:  John Doe, MD

ANESTHESIA:  General.

ESTIMATED BLOOD LOSS:  350 mL.

DESCRIPTION OF PROCEDURE:  The patient was marked preoperatively in the holding area. The patient was then brought back to the operating room where she was placed in the supine position with both upper extremities abducted on arm boards. The patient was induced and intubated without difficulty. She was sterilely prepped and draped in the usual fashion. We first performed the brachioplasty portion of the case by following our preoperative markings. The skin was first incised along the intermuscular septum and a posteriorly-based skin flap was elevated from the medial humerus to the axilla. This was taken again and elevated along the superficial fascial system of the arm until we had reached the edge of our marked out dissection. We advanced this skin flap anteriorly towards the area of redundancy, marked it, and then resected it. We irrigated copiously and obtained hemostasis using electrocautery. We then closed the wounds over closed suction drains, which were brought out through separate stab incisions in the axilla. They were closed with interrupted 3-0 Vicryl in the subcutaneous and the skin with running subcuticular 5-0 Monocryl. She was dressed with bacitracin, Adaptic, Kerlix, and Ace wraps. The arms were then wrapped and padded on arm boards and the patient was re-prepped and draped for the abdomen.

Again, following our preoperative markings, we elevated from the ASIS on the right to the left just above the mons pubis in a horizontal orientation. I elevated superiorly the skin flap at the level of the anterior abdominal fascia to the costal margins laterally and the xiphoid medially. After this, we made a circular incision on the umbilicus and dissected the umbilical stalk down to the fascia to avoid inadvertently undermining it as well. We then ran a plication stitch from the xiphoid to the pubis with a looped 0-nylon. We irrigated and obtained hemostasis using electrocautery. We then flexed the patient in a semi-Fowler position and advanced the superiorly-based skin flap inferiorly and judged the area of redundancy and resected it. We obtained hemostasis again and then closed over two drains, again brought out through a separate stab incision in the mons pubis, suturing into place with 2-0 silk. The horizontal incision was closed in layers with the Scarpa with interrupted 2-0 Vicryl, the subcutaneous with interrupted 3-0 Vicryl, and the skin with a running subcuticular 4-0 Monocryl. We made a circular incision in the midline, brought the umbilicus through this, and inset it with interrupted 4-0 Monocryl and interrupted 5-0 nylon. The wound was dressed with bacitracin, Adaptic, Kerlix, and paper tape. The patient was extubated and taken to recovery in stable condition.

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Parathyroidectomy Medical Transcription Operative Sample Report

PREOPERATIVE DIAGNOSIS:  Tertiary hyperparathyroidism.

POSTOPERATIVE DIAGNOSIS:  Tertiary hyperparathyroidism.

OPERATION PERFORMED:  Subtotal parathyroidectomy.

SURGEON:  John Doe, MD

ASSISTANT:  Jane Doe, MD

ANESTHESIA:  General. Fifteen mL of 0.5% Marcaine with epinephrine for local anesthesia.

ANESTHESIOLOGIST:  Bradford Doe, MD

DESCRIPTION OF OPERATION:  The patient was intubated with the Xomed nerve monitor endotracheal tube. The neck was prepped and draped in the usual manner after a shoulder roll was placed. A transverse cervical incision was made, and local anesthesia was infiltrated prior to the incision and as we finished the closure. Initial incision was deep and beyond platysma. Crossing anterior jugular vein branches were doubly ligated with 2-0 silk ties and divided. Superior subplatysmal flap was developed to the thyroid notch and the inferior flap to the sternal notch. Strap muscles were divided at the midline and separated.

The right strap muscles were lifted off the right thyroid gland and slowly mobilized the right thyroid gland medially. Did identify the nerve fairly early on at the base of the neck. There were two inferior thyroid artery branches that were ligated with 2-0 silk ties and divided. Middle thyroid vein was ligated with 2-0 silk tie and divided. This allowed for mobilization of the thyroid gland medially. The right upper parathyroid gland was found at the mid aspect of the posterior thyroid gland. It was intrathyroidal. Slowly freed it from the thyroid gland, clipped the feeding vessels, and removed it. The nerve was noted to be functional at the end of this excision.

The superior vascular bundle was doubly ligated with 2-0 silk ties and divided. This allowed for further mobilization of the gland medially. We were unable to find a parathyroid gland at that level. We then subsequently freed the lower pole of the thyroid gland and we started identifying the thymus tissue and pulled it out of the chest. There was a lymph node that was submitted and this was benign. We then identified a right lower parathyroid gland with the dimensions noted above. I clipped the distal half and submitted it to pathology, and this was confirmed to be parathyroid tissue. The proximal half of the parathyroid gland was left intact.

The left strap muscles were lifted off the left thyroid gland. The middle thyroid vein was ligated with 3-0 silk ties and divided and the thyroid gland was then mobilized medially. The nerve was found at the base of the neck and traced towards the larynx. The left upper parathyroid gland was identified, found to be posterior to the mid aspect of the thyroid gland, and it measured 1.5 x 0.8 cm. We freed it from the nerve and from the thyroid gland and submitted it to pathology, and this was confirmed to be parathyroid tissue. The small vascular pedicles were clipped. The nerve was noted to be functional at this point.

We ligated the superior thyroid vascular pedicle. This was done with 2-0 silk ties x2 and with a 3-0 silk suture ligature. We mobilized the gland medially, and not finding any parathyroid tissue superiorly, we then addressed our attention inferiorly where the thymus was pulled out and we identified a parathyroid gland. This was found to be anterior to the nerve. This gland was noted to be 1.1 x 0.9 x 0.8 cm. This was removed in its entirety. The vascular pedicles were clipped. At this point, both nerves were noted to be functional, and with assurance of hemostasis, we commenced closure. Running 4-0 Vicryls were used to approximate the strap muscles at the midline, interrupted 4-0 Vicryls were used to approximate the platysma, 5-0 Monocryl was used for the subcuticular skin closure. Local anesthesia was infiltrated. Dermabond was placed. The patient tolerated the procedure well. Sponge and needle counts were correct. Blood loss was minimal. The patient was taken to recovery room, extubated and in stable condition.

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ORIF of Supracondylar Humerus Fracture Medical Transcription Sample Report

PREOPERATIVE DIAGNOSIS:  Right supracondylar humerus fracture.

POSTOPERATIVE DIAGNOSIS:  Right supracondylar humerus fracture.

OPERATION PERFORMED:  Open reduction and internal fixation, right supracondylar humerus fracture, and subcutaneous ulnar nerve transposition.

SURGEON:  John Doe, MD

ANESTHESIA:  General endotracheal.

FLUIDS:  1700 mL crystalloid.

ESTIMATED BLOOD LOSS:  150 mL.

TOURNIQUET TIME:  120 minutes.

DESCRIPTION OF OPERATION:  The patient was brought to the operating room where general endotracheal anesthesia was induced.  The patient was then positioned in the left lateral decubitus position.  An axillary roll was placed and the patient was secured into position using a padded bean bag.  The peroneal nerves were padded.  The knees were well padded.  The patient was then prepped and draped in sterile fashion.  A sterile tourniquet was applied to the right proximal arm and Esmarch bandage was used to gently exsanguinate the limb.  Tourniquet was inflated to 250 mmHg.  A posterior midline incision was made centered about the olecranon process.  Dissection was carried out sharply to the level of the fascia and the fascia was incised.  Dissection was carried out medially and laterally, elevating full-thickness skin flaps.  Dissection was carried medially and the ulnar nerve was identified in the cubital tunnel.  Care was taken to visualize the ulnar nerve throughout the cubital tunnel, and I felt that to facilitate acceptable reduction and fixation of the fracture, that the ulnar nerve would need to be mobilized for the course of the surgery.

In light of this, the roof of the overlying fascia was released with Metzenbaum scissors.  The ulnar nerve was gently dissected free from the distal aspect of the humerus and freed.  Dissection was carried proximally along the ulnar nerve, taking care to release fascial attachments and muscular septae tethering the ulnar nerve.  Once it had been adequately mobilized, a loosely applied vessel loop was used to mark the ulnar nerve.  It was dissected free and away from the reduction site.  Then, exposure of the distal humerus was continued.  The triceps was elevated about the fracture line and the fracture line was noted to be transverse in nature just through the region of the olecranon fossa.

Visualization of the joint was limited, but the articular surface was felt to be completely intact without fracture lines extending into the joint.  Thorough irrigation of the fracture site was performed and initial reduction maneuver realigned the distal humerus with the proximal fragment.  Once it had been acceptably placed, temporary fixation with 0.0625 K-wires was accomplished.  Then, medial and lateral distal humerus locking plates were selected and the lateral plate was applied first.  The plate with the flange was selected to provide additional fixation into the distal humerus.  It was secured into preliminary position and secured with temporary K-wire.  Then, a cortical screw was placed from posterior to anterior direction and used to loosely approximate the plate to the distal humerus.  It had an excellent fit and did not require additional contouring.

Then, the locking sleeves were assembled onto the plate and a 2.0 drill bit was used to drill the track.  Appropriate length screws were selected from the depth gauge and 2.7 mm distal humerus locking screws were applied and locked into the plate without difficulty.  After this had been performed, a posterior-to-anterior screw was placed through the plate in a locking fashion as well with into the capitellum, taking care to stay short of articular surface.  After this had been performed, screws were placed into the proximal fragment and the plate was tightened into position.

Compression was applied across the transverse fracture pattern prior to securing the plate.  Then, a medial plate was selected at adequate position to the distal humerus.  I did not feel that contouring the plate would be helpful, as I thought that it might preclude the use of screws in the distal humerus fragment.  The plate was secured in a temporary fashion, and the distal humerus screws were placed in a locking fashion using the locking drill bit.  Initially, two screws were placed and secured and locked in a locking fashion.  Then, screws were placed proximally, using 3.5 mm cortical screws.

Intraoperative x-rays were obtained, and these demonstrated the distal humerus screws from the medial side to be somewhat long and I felt that they ought to be changed.  The screws were removed and a single distal locking screw was placed from the medial side.  A second distal lock had very little purchase, and I felt it better to leave this screw out.  Thorough irrigation of the wound was performed.  The elbow was taken through a full range of motion, and full extension and flexion were obtained and there was no motion at the fracture site noted.  Thorough irrigation of the wounds performed.  Hemostasis was ensured.  The vessel loop was released from the ulnar nerve.  It was noted to be without additional contusion or injury.  Upon placing the ulnar nerve back into the groove, it had some proximity to the medial plate, and in light of this, I felt that it would be better to allow the nerve to be positioned in the fashion away from the end of the medial locking plate.  A fascial tether was fashioned using 0 Vicryl in a subcutaneous fashion.  The ulnar nerve was inspected and noted to have full range without any limitation or impingement on the hardware.

A medium Hemovac drain was placed.  The fascia was approximated with 0 Vicryl in a figure-of-eight fashion.  Subcutaneous layer was closed with 2-0 Vicryl in an interrupted fashion and the skin was closed with staples.  Wounds were dressed with Xeroform, 4x4s, ABD pads, and sterile Webril.  Intraoperative x-rays were obtained.  These demonstrated acceptable placement of the hardware and acceptable reduction.  A long-arm posterior molded splint was applied.  The patient was positioned back into the supine position, awakened from anesthesia, extubated, and transferred to the recovery room in stable condition.

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Right Total Knee Arthroplasty Medical Transcription Operative Sample Report

PREOPERATIVE DIAGNOSIS:  Right knee degenerative joint disease.

POSTOPERATIVE DIAGNOSIS:  Right knee degenerative joint disease.

OPERATION:  Right total knee arthroplasty.

SURGEON:  John Doe, MD

ASSISTANT:  None.

ANESTHESIA:  General LMA.

ESTIMATED BLOOD LOSS:  100 mL.

DESCRIPTION OF OPERATION:  The patient was taken to the operating room and placed on the operating room table.  A tourniquet was placed.  After undergoing placement of a Foley and general anesthesia with placement of LMA, the patient’s right lower extremity was prepped and draped in standard fashion.  The leg was exsanguinated and the tourniquet was inflated to 275 mmHg.  The initial incision was made over the anterior aspect of the knee.  Dissection was carried sharply down to the extensor mechanism, where a second knife was used to create a medial arthrotomy.  The patella was everted and the knee flexed up.  Attention was turned to the distal femur after clearing up soft tissues and exposing the proximal medial part of the tibia.  The distal femur was cut at 5 degrees of valgus based on preoperative long leg templating.  Attention was then turned to the proximal tibia and that was then cut at 90 degrees to the mechanical axis of the tibia.  The patient did have a bow noted preoperatively.  Using a 10 mm rotating platform spacer block, the lateral side was little more loose than the medial side, and a limited medial release was then performed to obtain equal balance both medially and laterally in extension.

Attention was then turned to the flexion gap after sizing the tibia and femur at size 3.  Using a laminar spreader and a size 3 Ranawat block, the appropriate femoral rotation was dialed in to achieve equal balance medially and laterally in 90 degrees of flexion.  Using the Ranawat block, anterior and posterior cuts were performed, followed by notch cuts and chamfer cuts.  Trials were then inserted with a size 3 femur, a size 3 tibia, and a 10 mm spacer.  The patient had excellent balance throughout range of motion and flexed to approximately 145 degrees in the operating room with this construct.  All of the trials were then removed and the patella was then prepared for a 38 mm oval dome 3 peg patella.  The proximal tibia was then prepared for final implantation, and all bony surfaces were then thoroughly irrigated and dried.  Two bags of DePuy #3 cement were mixed on the back table.  Proximal tibial exposure was accomplished, and when the cement had reached an appropriate viscosity, the tibia was cemented into place with attention to removing any excess cement that had extruded from outside the implant.

Next, the femur was impacted into place using 10 mm trial insert.  The knee was then placed in extension and any excess cement was removed around the implants.  The patella was then cemented into place.  The undersurface of the quadriceps tendon was then debrided of any excess tissue.  The patient did have an excess amount of tissue underneath the quadriceps tendon due to some prior scarring from previous surgeries.  Once the cement dried, the knee was flexed up and any excess hard cement was removed using an osteotome and the wound was then thoroughly irrigated.  The patient had excellent balance medially and laterally with this construct.  The trial insert was removed and the final 10 mm size 3 posterior cruciate substituting insert was then implanted.  The knee reduced.  The tourniquet deflated at 70 minutes.  The knee was then flexed up and lateral release was not required today.  The wound was then irrigated again.  The arthrotomy was closed using 0 Vicryl, subcutaneous tissues using 2-0 Vicryl, and skin using staples.  The patient was then dressed with Xeroform, 4 x 4s, ABDs, Webril, a cooling pad, Ace wrap, and then a knee immobilizer.  The patient was transferred to the PACU in stable condition.

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Laparoscopic Adhesiolysis Medical Transcription Operative Sample Report

PREOPERATIVE DIAGNOSES:

1. Pelvic pain.

2. History of previous pelvic surgery and ovarian cyst.

POSTOPERATIVE DIAGNOSES:

1. Pelvic pain.

2. History of previous pelvic surgery and ovarian cyst.

OPERATION PERFORMED:  Laparoscopic adhesiolysis.

SURGEON:  John Doe, MD

ANESTHESIA:  General endotracheal.

ESTIMATED BLOOD LOSS:  Less than 10 mL.

URINE OUTPUT:  75 mL.

IV FLUIDS:  850 mL.

DESCRIPTION OF OPERATION:  After informed consent was obtained, the patient was taken to the operating room. She was placed in the dorsal supine position and general anesthesia was induced. The patient was then placed in dorsal lithotomy position in Allen stirrups and prepped and draped in the normal sterile fashion. A Foley catheter was placed to gravity. Speculum was placed in the posterior and anterior vagina and the cervix was grasped with a single-toothed tenaculum. A Hulka clamp was then inserted through the cervix into the uterus for uterine manipulation. The tenaculum was removed and attention was then turned to the abdomen.

A supraumbilical incision was made with a scalpel and elevated up with towel clamps. A long Veress needle was then placed and CO2 gas was used to insufflate the abdomen and pelvis. A 10-12 trocar and sleeve were then placed and intraabdominal placement was confirmed via the 0 degree laparoscope. Immediately, the dense omental adhesions to the anterior abdominal wall were noted. At this time, we were able to see into the pelvic region. A second trocar and sleeve were placed in the left mid quadrant under direct visualization. The size of this port was 5 mm. The ligature device was then placed developing a plane between the omentum and the anterior abdominal wall.

The adhesiolysis took place and it took approximately 30 minutes to get down all of the omental adhesions from the anterior abdominal wall. We were then able to visualize the pelvis and a blunt probe was placed through the port. The ovary was visualized and photos were taken. There was no evidence of any ovarian cyst or ovarian pathology. There was no evidence of pelvic endometriosis. The uterus also appeared normal and the left tube and ovary were surgically absent. The appendix was easily visualized and noted to be noninflamed, normal in appearance, and there were no adhesions in the right lower quadrant. The upper abdominal exam was unremarkable. A decision was made to conclude the procedure at this point. The ports were removed. CO2 gas was allowed to escape. The incisions were closed with 4-0 Vicryl suture. The Hulka clamp was removed. The vagina was noted to be hemostatic. The patient's anesthesia was reversed, the Foley catheter was removed, and she was taken in stable condition to the postoperative recovery room.

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Laparoscopic Bilateral Tubal Ligation Medical Transcription Sample Report

PREOPERATIVE DIAGNOSIS:  Multiparity, desires permanent sterilization.

POSTOPERATIVE DIAGNOSIS:  Multiparity, desires permanent sterilization.

PROCEDURE PERFORMED:  Laparoscopic bilateral tubal ligation with Filshie clips.

SURGEON:  John Doe, MD

ANESTHESIA:  General.

COMPLICATIONS:  None.

ESTIMATED BLOOD LOSS:  Minimal.

SPECIMENS:  None.

FINDINGS:  Normal uterus, tubes, and ovaries.

DESCRIPTION OF PROCEDURE:  The patient was taken to the operating room where general anesthesia was obtained without difficulty. The patient was then examined under anesthesia and found to have a small anteverted uterus and normal adnexa. She was placed in the dorsal lithotomy position and prepared and draped in the normal sterile fashion. A sterile speculum was then placed in the patient's vagina and the anterior lip of the cervix grasped with a single-toothed tenaculum and a uterine manipulator advanced into the uterus to provide a means of uterine manipulation during the surgery. The speculum was removed from the vagina at this time.

Attention was then turned to the patient's abdomen where a small skin incision was made in the umbilical fold. At this time, a 5 mm Optiview scope was carefully introduced into the peritoneal cavity under direct visualization while tenting the abdominal wall. Intraperitoneal placement was confirmed visually. At this time, the camera and blade were removed and the camera was reintroduced into the trocar with visualization of the abdominal cavity. At this time, CO2 was connected to the trocar and insufflation was begun. The pneumoperitoneum was obtained with approximately 3 to 4 L of CO2 gas. After insufflation, a full survey of the abdominal cavity was done, and there were no abnormalities visualized. At this time, a second skin incision was made 2 cm above the symphysis pubis, in the midline, and a second 7 to 8 mm trocar and sleeve were advanced under direct visualization.

At this time, a Filshie clip applicator was advanced through the second trocar sleeve and the patient's left fallopian tube was identified and followed to the fimbriated end. The Filshie clip applicator was then used to apply the clip in the mid isthmic area of the tube. The clip was noted to be applied to include the entire circumference of the fallopian tube. There was no bleeding noted at this time. The Filshie clip applicator was then removed and reloaded, and the patient's right tube identified in a similar fashion and easy application of the Filshie clip in the same fashion was completed.

The instruments were then all removed from the patient's abdomen and pneumoperitoneum resolved. The incisions were then closed with Dermabond. The uterine manipulator was then removed from the cervix and vagina. There was no bleeding noted from the cervix. The patient tolerated the procedure well. Sponge, lap, and needle counts were correct x 2. The patient was taken to the recovery room in stable condition.

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Laparoscopy and Biopsy Medical Transcription Transcribed Sample Report

PREOPERATIVE DIAGNOSIS:  Recurrent ascites with history of breast cancer and endometrial tumor markers.

POSTOPERATIVE DIAGNOSES:

1.  Recurrent ascites with history of breast cancer and endometrial tumor markers.

2.  Probable peritoneal carcinomatosis.

PROCEDURES PERFORMED:

1.  Laparoscopy.

2.  Multiple biopsies.

SURGEON:  John Doe, MD

ASSISTANT:  Jane Doe, MD

ANESTHESIA:  General endotracheal.

DESCRIPTION OF PROCEDURE:  The patient was brought to the operating room and placed in the supine position on the operating table.  General anesthesia was induced.  Venodyne boots were then placed.  A Foley catheter was inserted into the bladder.  The abdomen was prepped with Betadine and draped in the usual manner.  The patient was placed in Trendelenburg position.  A 1 cm incision was made just above the umbilicus because of previous lower midline surgical scar.  The fascia was grasped and a disposable Veress needle passed into the peritoneal cavity.  Initially, low pressures were obtained and carbon dioxide was insufflated.  However, the pressure became elevated with insufflation of small amount of CO2.  It was therefore decided to do an open Hasson technique.

The fascia was incised between forceps.  Opening identified adjoining cavity.  Finger was introduced to make sure there had been no adherent bowel loops.  The Hasson cannula was then introduced into the peritoneal cavity and kept in place with 2-0 Vicryl sutures.  Carbon dioxide was insufflated to an intraperitoneal pressure of 15 mmHg.  A laparoscope and camera were introduced and the interior of the abdomen examined.  The liver had a pale pink granular appearance to it.  There were fine nodules, whitish in appearance, seen on the falciform ligament, as well as on the peritoneal surface.  There is also tapering of the omentum in the right upper quadrant.  There were no significant tumor deposits or nodules seen.  These fine miliary nodules also involved some of the bowel loops, as well as the peritoneal surfaces.  It was decided to remove a sample for biopsy from the falciform ligament.

A 5 mm cannula was introduced in the right upper quadrant, as well as in the left lower quadrant.  The nodules in the falciform ligament were grasped, and using the scissors and electrocautery, a biopsy specimen was obtained.  This was sent to pathology.  We also then decided to do a liver biopsy.  The abdomen was desufflated to a pressure of 8 mmHg.  A Tru-Cut needle was then introduced in the right upper quadrant, and under vision, two core biopsy specimens were obtained.  These were also sent to pathology.  Next, we decided to obtain a sample of the peritoneal nodules.  One of these was grasped, and using electrocautery and scissors, it was shaved off and sent to pathology.  Pathology reported that these represented metastatic carcinoma, probably lobular breast cancer. 

After taking off the ascitic fluid, the cannula was withdrawn under vision.  Hemostasis was achieved in the liver with electrocautery and also at the other biopsy sites.  The fascia was closed at the umbilical site with running 0-Vicryl suture using a J needle.  Marcaine 0.25% was infiltrated into all the port sites.  The skin incisions were closed with 3-0 Vicryl subcutaneous and subcuticular sutures.  Steri-Strips and Band-Aid dressings were applied.  Blood loss was minimal.  The patient tolerated the procedure well and was transferred to the recovery room in good condition.

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Neurosurgery Medical Transcription Operative Transcribed Sample Report

PREOPERATIVE DIAGNOSIS:  Spondylosis and right disk herniation, L5-S1.

POSTOPERATIVE DIAGNOSIS:  Spondylosis and right disk herniation, L5-S1.

OPERATIONS PERFORMED:  Right hemilaminectomy, medial facetectomy, foraminotomy, and diskectomy at L5-S1, on the right.

SURGEON:  John Doe, MD

ANESTHESIA:  General.

ESTIMATED BLOOD LOSS:  Minimal.

COMPLICATIONS:  None.

DESCRIPTION OF OPERATION:  The patient was taken to the operating room.  After general endotracheal anesthetic, the patient was rolled prone on gel rolls.  We positioned and secured the trunk and appendages.  The patient was given 1 gram of perioperative antibiotics prior to the incision.  After the patient was prepped and draped in the usual fashion, PA and lateral fluoroscopy was used to help plan a paramedian incision at L5-S1, on the right, over the lateral mass.  The planned incision was infiltrated with Marcaine and sharp incision was carried through the skin, subcutaneous, and deep fascia.

A K-wire was brought down towards the lateral mass through the muscles.  Sequential dilators were placed over it and then a 4 cm x 22 mm METRx retractor was placed and affixed to the table with an attachment arm.  We confirmed our position on lateral fluoroscopy and did a hemilaminectomy and medial facetectomy with a 5 mm diamond bur on the Midas Rex drill, completed foraminotomy and medial facetectomy with 2 and 3 mm Kerrison rongeurs, identified the common dural sac, identified the S1 nerve root which was compressed underneath the ledge of facet, and with an underlying combination of osteophyte and disk herniation, the nerve root was gently mobilized with a Penfield 4 dissector, retracted with #8 French suction retractor.

An annulotomy was made with an 11 blade under loupe magnification and fiberoptic illumination after placing 1 mL of Marcaine irrigated on the S1 nerve root prior to retracting it.  We entered the disk space, removed some adjacent disk material, completed an S1 foraminotomy and medial facetectomy.  As the L5 nerve root was able to be easily palpated along its course, going out of a rather narrow foramen at this level as well, we attempted to try and open this up by undercutting a little bit more of the superior facet of S1, but this would have required a full facetectomy to further decompress and we did not want to destabilize the spine at this level by doing so. 

Hemostasis was adequate.  There were no complications.  No CSF leak.  The wound was copiously irrigated with antibiotic irrigation, and then, after that was aspirated out, we again placed another 1 mL of Marcaine over the nerve roots, removed the retractor, infiltrating the muscle and the subcutaneous tissue with more Marcaine.  The deep fascia was reapproximated, after ensuring excellent hemostasis, with 2-0 Vicryl.  The subcutaneous was closed with 2-0 Vicryl and subcuticular suture was used with 4-0 Vicryl and Steri-Strips to close the skin.  Sterile dressing was applied.  The patient was rolled onto his back and allowed to awaken.  The patient was then taken to the recovery room in good condition.

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Oral and Maxillofacial Surgery Transcribed Operative Sample Report

DATE OF OPERATION: MM/DD/YYYY

PREOPERATIVE DIAGNOSES:
1. Maxillary hypoplasia.
2. Mandibular hyperplasia.
3. Skeletal class III jaw deformity.

POSTOPERATIVE DIAGNOSES:
Not Available.

OPERATIONS PERFORMED:
1. LeFort I total maxillary osteotomy with rigid skeletal fixation utilizing titanium bone plates and screws and onlay bone grafting with allogenic bone.
2. Bilateral mandibular ramus osteotomies with skeletal/dental intermaxillary fixation.

SURGEON: John Doe, DDS

ASSISTANT: Jane Doe, DMD

ANESTHESIA: General.

ANESTHESIOLOGIST: Bradford Doe, MD

DESCRIPTION OF OPERATION: The patient was taken to the operating area in a sedated condition and placed in a supine position on the operating table. After the successful induction of anesthesia and the placement of a nasal endotracheal tube, the patient was prepared and draped in the usual manner for an intraoral surgical procedure. Attention was directed intraorally. The oropharynx was suctioned freed of all secretions and debris. A throat pack was placed about the endotracheal tube. Xylocaine 2% with 1:100,000 epinephrine was then infiltrated in the maxillary labial areas and into the bilateral ramus areas of the mandible. Then, 0.5% Marcaine with 1:200,000 epinephrine was used to get bilateral inferior alveolar nerve blocks. After the placement of the local anesthetic, Ivy loop appliances were applied to the maxillary and mandibular molar dentition on both the right and left side.

Attention was then directed to the right ramus where, by the use of a #15 Bard-Parker blade, incision was made over the external oblique ridge, going from the mid portion of the coronoid process down to the distal of the second molar. Dissection was carried off the lateral surface of the mandible to expose the lateral surface of the mandible from the sigmoid notch superiorly, inferiorly to the facial notch and posteriorly along the posterior border of the mandible. At this time, a Bauer retractor was placed into the sigmoid notch and a Merrill retractor was placed along the posterior border of the mandible to allow for access for the osteotomy. At this time, utilizing a reciprocating saw and the Stryker handpiece, a vertical osteotomy cut was initiated just through the lateral cortex, going from the sigmoid notch superiorly down to the angle. Once the osteotomy cut had been scored, moist dressing was placed in the surgical site and attention was directed to the left ramus area, where similar dissection and similar initially osteotomy cuts were accomplished.

At this time, attention was directed to the maxilla where, by the use of a #15 Bard-Parker blade, incision was made in the greatest depths of the mucobuccal fold, going from the first molar posteriorly, anteriorly to the midline. Dissection was carried off the anterior face of the maxilla to expose the maxilla from the piriform aperture anteriorly, posteriorly to the pterygoid plates, and superiorly to just below the infraorbital nerve. Further dissection was carried to elevate the nasal mucosa from the superior portion of the maxilla and the lateral nasal wall. A small malleable retractor was then placed. A 701 fissure bur was then used to make indicating marks above the apices of the cuspid and molar teeth, and then utilizing a reciprocating saw and the Stryker handpiece, an osteotomy cut was made from the pterygoid plates posteriorly to the piriform aperture. A small osteotome was used to continue the osteotomy along the lateral nasal wall to the perpendicular plate of the palatine bone and along the lateral maxillary wall to the pterygoid plates. A gently curved osteotome was then used to separate the pterygoid plates from the distal aspect of the maxilla. Once this had been accomplished, a nasal septal osteotome was used to separate the nasal septum and vomer from the superior aspect of the maxilla.

Now, utilizing firm finger pressure, down-fracture maneuver was accomplished. The Le Fort I osteotomy was then mobilized to freely move it anteriorly. The greater palatine vessels were intact on both the right and left side. Further bone was removed from the superior portion of the maxilla to allow for free advancement. Rowe disimpaction forceps was used to freely mobilize the maxilla in all dimensions. At this time, a previously prepared acrylic intermediate splint was brought intraorally and the maxilla was brought into its anatomically determined occlusion and secured by the use of multiple 25 gauge stainless steel wires. The maxillomandibular complex was then superiorly repositioned into its appropriate anatomic relationship, having been advanced approximately 6 mm. A 1.7 mm titanium L-plate was adapted to the right and left piriform aperture and secured by the use of five 5 mm titanium bone screws of 1.7 mm diameter. In the posterior maxilla, 2-hole plates were contoured to fit across the osteotomy and these were 2 mm plates that were secured with two 2 x 5 mm titanium bone screws.

Once this had been accomplished, it was found that the maxilla had been rigidly stabilized. Prior to stabilization, the superior port of the maxilla along the nasal crest was smoothed with a rotating cutting instrument and a few millimeters of nasal septal cartilage was removed to allow for free repositioning of the maxilla and the soft tissue was closed by the use of interrupted and continuous running 4-0 Vicryl sutures. Now that the maxillary osteotomy had been well stabilized, the intermaxillary fixation was released, the intermediate splint was then removed, the oropharynx was suctioned free of all secretions and debris and the moist throat pack was removed about the endotracheal tube.

At this time, a previously prepared acrylic splint in its final jaw relationship was brought intraorally and tested on the dentition. At this time, attention was then directed to the right and left ramus areas where, by the use of an oscillating saw, a vertical osteotomy was completed, going from the greatest depth of the sigmoid notch down to the angle of the mandible. The proximal fragment was then brought laterally. Muscle attachments on the medial aspect were removed. Osteotomies were accomplished on both the right and left side. At this time, the mandible could be freely repositioned into its anatomically determined occlusion and the previously placed throat pack had been previously removed. The acrylic splint was used to reposition the mandible ideally into its anatomic location and the patient was secured into intermaxillary fixation utilizing multiple 25 gauge stainless steel wires.

Attention was then directed to the ramus area, where the inner aspect of the proximal segment was smooth with rotating cutting instruments so that the proximal segment laid passively against the distal segment. A 1.1 mm wire pass bur was used to place a transosseous wire through the lateral cortex of the distal segment through which a 26 gauge stainless steel wire was placed. This was passed around the posterior aspect of the proximal segment. The posterior segment was then gently but firmly seated into the glenoid fossa and this transosseous wire was tightened, to secure and stabilize the proximal segment to the lateral aspect of the distal segment. Once this wire had been placed and tightened, it was turned down into the bony crevice.

At this time, it appeared that both osteotomies had been positioned appropriately. At this time, a piece of iliac crest that had been procured from allogenic bone bank had been reconstituting in normal saline with a gram of Kefzol. The reconstitution was to fill any bone cavities and soften the bone for placement. An area on the anterior face of the maxilla measuring 23 x 5 x 5 mm was noted and a piece of this allogenic cadaver bone was cut into two segments that were 23 x 6 x 5 mm in height. This was shaped and contoured to fit the anterior face of the maxilla on both the right and left side. Two separate pieces were contoured. Once they had been contoured to fit, 2 mm stabilizing screws were placed, both 8 mm in length x 2 mm in diameter, to secure and stabilize the allogenic bone graft along the anterior face of the maxilla. This was accomplished on both the right and left side to 22 to 23 mm x 5 to 6 mm x 5 mm pieces of allogenic bone obtained from the allogenic cadaver iliac bone was placed on the maxilla and stabilized. The margins were re-contoured for proper facial balance.

At this time, the surgical area was irrigated with copious amounts of normal saline. A double skin hook was placed in the midline. A single skin hook was then used to grab the transverse nasalis muscle on both the right and left side, through which a 3-0 Ethibond suture was placed. This was tightened to re-anastomose the transverse nasalis muscle across the anterior part of the maxilla and floor of nose to help prevent widening of the alar base. Once this had been accomplished, a V-Y closure of the maxillary vestibular incision was accomplished utilizing interrupted and continuous running 3-0 Vicryl suturing. The V-portion was advanced toward the midline, approximately 5-10 mm and the Y-portion was closed by the use of interrupted 3-0 Vicryl suturing.

At this time, attention was directed to the ramus area on both the right and left side. The area was irrigated with copious amounts of normal saline. Medium Hemovac drains were placed bilaterally and the soft tissues closed by the use of interrupted and continuous running 3-0 chromic suture. Blood loss for the procedure was approximately 800 mL. Sponge count and needle counts were correct at the termination of the operation. The patient was administered Kefzol three times during the operation and dexamethasone 10 mg during the course of the operation. The patient tolerated the procedure well, was extubated in the operating room and transferred to the recovery area in a stable condition.

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Laparoscopic Pyloromyotomy and Removal of Neonatal Tooth Medical Transcription Operative Sample Report

PREOPERATIVE DIAGNOSES:

1.  Pyloric stenosis.

2.  Neonatal tooth.

POSTOPERATIVE DIAGNOSES:

1.  Pyloric stenosis.

2.  Neonatal tooth.

OPERATIONS PERFORMED:

1.  Laparoscopic pyloromyotomy.

2.  Removal of neonatal tooth.

SURGEON:  John Doe, MD

ANESTHESIA:  General.

DESCRIPTION OF OPERATION:  The patient was brought to the operating room and prepped and draped in the usual sterile fashion in the supine position.  After adequate general anesthesia was obtained, an incision was made in the umbilicus.  This was carried down through the subcutaneous tissues with a knife and then a Step sheath with Veress needle was placed into the abdominal cavity.  A 5 mm trocar and port were then placed through the sheath and into the abdomen.  We then placed a right upper quadrant 3 mm trocar and port, and the pyloromyotomy blade was brought into the mid upper abdomen under direct vision with the camera.  Once all the tools were in place, the first part of the duodenum distal to the pylorus was grasped in the normal area and an incision was made over the pylorus, which was quite hypertrophic on visual examination and palpation. This was carried down to the normal stomach.

The pyloromyotomy blade was used to make this incision, and then, after the incision was initially made, the blade was retracted and the blunt portion of the pyloromyotomy tool was used to separate the muscle initially.  The muscle separated and it was bluntly separated throughout its entire length from the normal stomach down to duodenum.  There was no evidence of bile or gastric extravasation seen and the mucosa appears intact.  The two edges of the pylorus muscle itself did move independently at the end of the procedure indicating an adequate pyloromyotomy.  Again, some pressure was placed on the stomach in order to try and determine if there was any egress of gastric contents and none was seen.

All the ports were then removed and then a 3-0 Vicryl stitch was used to close the fascia of the umbilical port site.  The skin was closed with three interrupted 5-0 Monocryl sutures and then a single interrupted 5-0 Monocryl suture was used in the right upper quadrant site.  Only a Steri-Strip was needed for the pyloromyotomy blade access site.  After dressings were finally applied and 0.25% Marcaine was used for local anesthesia postoperatively, the patient was then woken up out of anesthesia.  Just prior to awakening from anesthesia, the neonatal tooth that was seen initially was removed by simply taking a toothed Adson and using gentle turning motion to bring the tooth out.  The tooth was removed easily and without complication and the area had pressure held on it for approximately 4 minutes to control the bleeding.  It was completely hemostatic after a few minutes of pressure and then the patient was woken up out of anesthesia and brought back to the recovery room in good condition.  The patient tolerated the procedure well.  Sponge and needle counts were correct at the end of procedure.

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Cystoscopy, Transurethral Resection and Fulguration of Bladder Tumor Medical Transcription Operative Sample Report

PREOPERATIVE DIAGNOSIS:  Bladder tumor.

POSTOPERATIVE DIAGNOSIS:  Multiple bladder tumors.

PROCEDURES PERFORMED:

1.  Cystoscopy.

2.  Transurethral resection of the bladder tumor.

3.  Fulguration of bladder tumor.

SURGEON:  John Doe, MD

ASSISTANT:  None

ANESTHESIA:  General endotracheal.

ESTIMATED BLOOD LOSS:  Less than 100 mL.

INTRAVENOUS FLUIDS:  Crystalloids, 1.6 liters.

SPECIMENS:  Bladder tumor.

DRAINS:  A 22 French 3-way Foley catheter.

COMPLICATIONS:  None.

DESCRIPTION OF PROCEDURE:  The patient was brought to the cystoscopy suite.  He was placed in the dorsal lithotomy position and given IV sedation.  His penis was prepped and draped and 2% lidocaine jelly was injected retrograde per urethra.  Flexible cystoscopy was performed.  The anterior urethra was normal.  Prostatic urethra with mild bladder neck elevation.  The bladder was entered and a very large bladder tumor was immediately encountered on the right side of the bladder towards the trigone.  The cystoscope was then removed.  Anesthesia was informed of the findings and the patient was then placed under general endotracheal anesthesia with muscle paralysis.  Van Buren sounds were passed from 20 to 26 French.  The dilation was snug distally and I opted not to dilate any further.  Instead of the 28 French continuous flow resectoscope, I used a 24 French bipolar resectoscope with saline irrigation.

The resectoscope was placed and the bladder was briefly inspected.  The left orifice was identified and a small cautery mark was placed distal to this.  The right orifice could not be seen due to large overlying tumor.  The tumor had very coarse papillary features.  Very large submucosal blood vessels could be seen coursing through the posterior bladder and the bladder neck area.  The tumor was systematically resected carrying it down to the level of the bladder wall.  Towards its proximal extent and lateral extent, it was resected down into the muscle layer.  In between this, deep resection was not performed because I was concerned about the underlying ureter.  Bleeders were cauterized as they were encountered.  Eventually, the entire tumor could be removed.  The tumor fragments were evacuated and submitted for pathology.  The patient was given indigo carmine.  Clear blue efflux was seen from the left orifice.  Eventually, blue efflux could be seen just distal to the area of resection.  The bladder was inspected further with the resectoscope.  Numerous small papillary fronds were noted around the anterior bladder neck and these were cauterized.  Some of them appeared to be just out of view around the inner aspect of the prostate, on the bladder neck side.

The resectoscope was removed and replaced with a regular 22 French cystoscope.  With a 12- and 70-degree lens, the bladder was more fully inspected.  Three lesions were encountered across the posterior wall.  These were broad-based with coarse papillary features as well, each measuring under 1 cm in size.  These were fulgurated with a Bugbee electrode.  Additional fulguration was performed around the bladder neck edge.  There was no evidence of any additional bleeding.  The bladder was free of any clots or large tissue fragments.  The cystoscope was removed and replaced with a 22 French 3-way Foley catheter.  The balloon was inflated with 30 mL and the catheter was started on continuous irrigation with clear blue output.  A size 15 B & O suppository was placed per rectum to manage postoperative spasms.  The patient was awakened, extubated, and transported to the recovery room in stable condition.

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Da Vinci Nerve-Sparing Radical Retropubic Prostatectomy Medical Transcription Operative Sample Report

PREOPERATIVE DIAGNOSIS:  Adenocarcinoma of the prostate.

POSTOPERATIVE DIAGNOSIS:  Adenocarcinoma of the prostate.

OPERATION PERFORMED:  Da Vinci nerve-sparing radical retropubic prostatectomy.

SURGEON:  John Doe, MD

ASSISTANT:  Jane Doe, MD

ANESTHESIA:  General.

ESTIMATED BLOOD LOSS:  650 mL.

DESCRIPTION OF OPERATION:  After adequate general anesthesia had been achieved, the patient was prepped and draped in the dorsal lithotomy position with good padding of all extremities and portions of the body.  At this point, five incisions were marked in the abdominal wall for placement of trocars.  A small incision was made in the supraumbilical area 2 cm in length.  This was cut down to the fascia and a Veress needle was inserted in the pelvis through the peritoneal cavity.  Insufflation was begun through the Veress needle.

Once pneumoperitoneum was obtained, then two ports were placed on the right side of the abdomen as well as on the left side of the abdomen.  The two on the right included the fourth arm and the right arm.  On the left side, one port was placed for the assistant, another port was placed for the left arm, and actually a sixth 5 mm port was placed for the assistant as well.  At this point, we then proceeded to place the trocar through the supraumbilical incision and the telescope was inserted into pelvis.  No evidence of any significant adhesions was noted, and at this point, all the ports were placed under direct vision with Marcaine infiltration of the skin and fascia.

Once these had all been placed, then the robot was docked, and we proceeded to take down the peritoneum from the anterior abdominal wall and pubis and proceeded to mobilize the prostate.  The dorsal venous complex suture was placed of 2-0 Vicryl and another one was placed proximally on the prostate.  We then proceeded to cut the endopelvic fascia and mobilize the levator away from the prostate.  At this point, we then placed the hook and monopolar on opposing arms on the right and left arms and proceeded to dissect through the prostatovesical junction with cautery dissection and traction.  Once we had isolated the Foley catheter in the bladder, this was removed from the bladder and used for traction.

We then proceeded to transect the rest of the prostatovesical junction, identifying the ampulla of the vas and the seminal vesicles.  These were cauterized at their bases with care to avoid injury to the neurovascular bundles.  The assistant then proceeded to do the nerve-sparing portion of the procedure, and using monopolar hook and bipolar cautery, he was able to create a veil, preserving neurovascular bundle on each side and mobilizing the prostate off the anterior wall of the rectum with care.  The urethra was then transected and I proceeded to do the urethrovesical anastomosis with a running 2-0 Monocryl suture, double-armed.

At the end of the procedure, the anastomosis was checked after 24 French 30 mL balloon catheter was placed in the bladder and there were no leaks.  We then proceeded to place a drain in the pelvis, Surgicel, and proceeded to release the pneumoperitoneum and close the supraumbilical incision after the prostate was removed in the Endo Catch from the abdomen.  A #1 Vicryl suture was placed to close the fascial opening and 4-0 Vicryl was used on the skin, with Steri-Strips.  The patient tolerated the procedure well and was transferred to postanesthesia recovery room in good condition.  At the end of the procedure, the patient had a well-appearing neurovascular bundle on each side.

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