LAPAROSCOPIC

APPENDECTOMY DICTATION
Dr.Hassan’s operative notes for laparoscopic appendectomy in a nutshell

 Note:
o This operative note was taken from surgical books and tailored as what we are doing in our

institution.

o This note is only to guide you in your post operative dictation and it should not be always the

same.

o You can manipulate the note according to the actual operation done in your institution.

o Some surgeons have different techniques so you have the right to manipulate the note.

[DATE]
[COMPANY NAME]
[Company address]
Preoperative Diagnosis: Acute Appendicitis.

Procedure: Laparoscopic Appendectomy.

Postoperative Diagnosis: Same

Anesthesia :

 General anesthesia with endotracheal intubation and assisted mechanical ventilation.

Position of patient:

 Initially supine with arms abducted and extended, Then after induction of pneumoperitoneum the
patient is placed in Trendelenburg position with right side up.

Procedure :

 Time-outs were performed using both pre-induction and pre-incision safety checklists to verify correct
patient, procedure, site, and additional critical information prior to beginning the procedure
 Pre-operative antibiotics given as per policy.
 Pneumatic compression device applied to lower extremity and turned on.
 Antiseptic prepping and draping done; From midchest to lower abdomen.
 intra-abdominal pressure is preset to 15 mm in automatic insufflator. supraumbilical small incision is
made and hasson’s open technique used for insertion of main 10 mm trocar.
 Using a J needle a stay suture taken for later closure of the port site.
 Insufflation tube is connected to the trocar and Establishment of pneumoperitoneum done.
 A 10 mm 30-degree camera is inserted into the peritoneal cavity through the supraumbilical trocar.
 Inspection of the peritoneal cavity done.
 Introduction the next two ports are made under direct vision:
o 5 mm port was inserted above the symphysis pubis and below the hair line.
o 5 mm port was inserted in the Left lower quadrant lateral to rectus sheath.
 The cecum was manipulated with a grasper and the appendix was identified.
 The appendix was then grasped with a Babcock forceps and elevated exposing the base of the appendix.
 The appendix was noted to be inflamed/gangrenous/perforated.
 A window was developed in the mesoappendix at a point between the base of the appendix and the
cecum.
 The mesentery was serially divided with clips/cautery/ultrasonic shears.
 A pre-tied endoloop was then passed over the appendix and snugged tight at the base.
 A second endoloop was similarly placed distal to the first.
 The appendix was divided in between the two endoloops using an endoscopic shear.
 The appendix was placed into an endoscopic retrieval bag and removed via the 10-mm port site.
 The appendiceal stump was then irrigated and hemostasis was assured.
  Fluid was suctioned from the right lower quadrant and pelvis. The terminal ileum was run and found to
be normal with No other pathology identified.
 All ports removed under vision and heamostasis maintained by diathermy.

Closure and disposition:

 Camera port closed using the previously established suture.

 Other port sites closed in subcuticular manner.
 Steri-Strips applied and dressing done for the wounds.
 The patient was extubated in the OR he tolerated the procedure well and shifted to post-anesthesia care
unit in good condition.

Postoperative management:

 Keep the patient NPO until the patient is fully awake then start the patient on soft diet and advance as
tolerating.
 Keep the patient on Intravenous fluid in form of D5NS at a rate of 100 ml/h and stop as the patient is
tolerating orally.
 Ambulate the patient as early as possible.
 Teach the patient how to use incentive spirometry and encourage its usage.
 Analgesia :
o Injection Perfalgan 1G Intravenous QID.
o Injection pethidine 75 mg Intramuscular TID PRN for severe pain.
 Antibiotics:
o inj. cefuroxime 1.5 G Intravenous TID.
o inj. Metronidazole 500 mg intravenous TID.
 GI prophylaxis :
o Injection Pantoprazole 40 mg Intravenous once daily.
 DVT prophylaxis :
o Keep the patient on pneumatic compression while on bed.
o Keep the patient on injection Clexane 40 mg Subcutanouse once daily.
 Antiemetic:
o Keep the patient on ondansetron 8 mg IV TID PRN if nausea or vomiting.
 Monitoring of pulse, blood pressure, respiration, temperature and urine output.
 Surgical drain care as follow ( if there is any ):
o keep drain on negative pressure.
o monitoring of its output including, color, amount