DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: High grade carcinoma of the endometrium.
POSTOPERATIVE DIAGNOSIS: High grade carcinoma of the endometrium.
OPERATION PERFORMED:
1. Robotic laparoscopic hysterectomy and bilateral salpingo-oophorectomy.
2. Laparoscopic pelvic lymphadenectomy.
SURGEON: John Doe, MD
ANESTHESIA: General.
ESTIMATED BLOOD LOSS: 100 mL.
DESCRIPTION OF OPERATION: Under adequate general anesthesia, the patient was placed in the dorsal supine position using the split-leg stirrups. She was prepped and draped in the standard manner. An incision was made 2 cm above the umbilicus. The incision was carried down through the fascia and into the peritoneal cavity. The US surgical trocar was inserted and the balloon was insufflated. The laparoscope was then introduced through this trocar. The 8 mm trocars were then inserted into the right and left lower quadrant and a 12 mm trocar inserted into the left upper quadrant. The abdomen and pelvis was inspected. There was no evidence of metastasis. The uterine corpus and adnexa were grossly unremarkable. Washings were taken from the pelvis. The camera was then removed and the da Vinci robot was docked to the patient.
Attention was then turned to the surgeon's console. The round ligaments on both sides were cauterized and transected and the retroperitoneal spaces were developed. No gross adenopathy was appreciated. The bladder was taken down using sharp dissection; however, there were some adhesions along the bladder flap due to the previous cesarean section. The infundibulopelvic ligaments on both sides were cauterized and transected. The adnexa were then mobilized. The uterine vessels on both sides were cauterized and transected. The cardinal ligaments were then cauterized and transected and dissection extended down to the vaginal cuff. The bladder was further mobilized. Following this, the vaginal probe was inserted into the vagina. The posterior cul-de-sac was incised and a posterior colpotomy was performed. This was similarly done anteriorly. Remaining attachments to the uterosacral ligaments and cardinal ligaments were then cauterized and transected. The remaining vaginal attachments were then cauterized and transected. The entire specimen was mobilized and grasped with a single-tooth tenaculum, which was inserted through the vagina. The specimen was easily extracted through the vagina. Frozen section revealed a superficial malignant tumor of the endometrium.
Following this, the retroperitoneal space on the right side was exposed. The peritoneal incision extended up to the distal common iliac area. The bifurcation of the common iliac artery was identified and the ureter was also identified and retracted medially and cephalad. First, a biopsy was taken from the distal common iliac lymph nodes. Next, an en bloc pelvic lymphadenectomy was performed. Lymph nodes were removed beginning over the external iliac artery and extending down towards the groin. The nodes along the external iliac vein were then mobilized. The dissection then extended down to the hypogastric artery and the obliterated umbilical artery. Next, the obturator space was exposed and the obturator nerve identified. The lymph nodes from the obturator fossa were then removed along with the specimen. All of these lymph nodes were then inserted into an EndoCatch bag and sent to pathology.
On the left side, the distal descending colon was mobilized and the sigmoid colon was reflected towards the right. The right ureter and bifurcation of the iliac artery was identified. A similar dissection was then performed. Lymph nodes were removed beginning along the anterior lateral surface of the external iliac artery. The lymph nodes were mobilized and pulled medially. These were then dissected off the external iliac artery beginning at the bifurcation of the common iliac artery and extending towards the groin. The lymph nodes were then removed from the external iliac vein. The dissection extended down along the hypogastric artery until the left obturator nerve was identified. The lymph nodes were then removed from the obturator fossa. These specimens were also inserted into an EndoCatch bag and brought out through the 12 mm trocar and sent to pathology.
Following this, the vaginal cuff was closed with 0 Vicryl suture using Lapra-Ty. The pelvis was irrigated with warm normal saline. Hemostasis appeared satisfactory at this time. The instruments and the camera were removed. The da Vinci was undocked. The camera was reinserted and the trocars removed under direct visualization. Following this, the fascia was closed with 2-0 Vicryl suture and the skin closed with subcuticular 4-0 Vicryl suture. Final sponge and needle counts correct. The patient tolerated the procedure well and was sent to the recovery room in satisfactory condition.
