Xuanwu Hospital of Capital Medical University
Surgical Record Hospitalization Number：XXXXXX
Name: Wang Yuehua, Department of General Surgery, Xuanwu Hospital, Capital Medical University
Sex Female
Age 42 years old
Department of general surgery 1
Bed number 503-03
Preoperative diagnosis: giant cavernous hemangioma in the left lobe of the liver, hemangioma in the right lobe of the liver
Intraoperative diagnosis: same as preoperative diagnosis
Operation name: laparoscopic exploration, laparoscopic hepatic left outer lobe resection, radiofrequency ablation of hemangioma in the right lobe of liver
Surgeon: Deputy Chief Physician Yuehua Wang
Assistants.
Operation time: 2011
May
Started at 9:00, finished at 12:30
Anesthesia method: general anesthesia
Bleeding volume: 300ml
Blood transfusion volume: 136ml (autologous blood)
Surgical procedure, intraoperative conditions and treatment.
The patient was placed in the supine position, and after successful general anesthesia with tracheal intubation, the field was routinely disinfected with iodine and alcohol and sterile sheets were laid. An incision was made above the umbilicus, about 1 cm in length, and a pneumoperitoneum needle was inserted to establish a pneumoperitoneum, and a Trocar was inserted to enter the scope for exploration.
Three more punctures were made below the subclavian process, below the rib margin of the left midclavian line, and below the rib margin of the right midclavian line, respectively, and Trocar and operating forceps were placed to assist in the exploration. Exploration: There was no ascites in the abdominal cavity. The liver was normal in size and showed no cirrhosis. A large cavernous hemangioma was seen in the left outer lobe of the liver with an outward projecting growth of about 10 cm × 7 cm. The gallbladder was normal in size and shape. After intraoperative discussion, it was decided to perform laparoscopic hepatic left outer lobe resection and radiofrequency ablation of hemangioma in the right lobe of the liver.
The perihepatic ligaments such as the hepatic round ligament, sickle ligament, left deltoid ligament and hepatogastric ligament were firstly freed to make the liver tumor easy to reveal and control. At a distance of 1~1.5 cm from the edge of the tumor, radiofrequency needle is used to stop the hemorrhage and then resect the liver. The trauma is stopped by electrocoagulation with an electric knife, and when a vascular structure is encountered, the hemorrhage is stopped by clamping with a titanium clip, and the tumor is removed smoothly. The hemangioma of the right lobe of the liver was treated with radiofrequency ablation again. The liver trauma was rinsed and re-examined, and there was no active bleeding in the abdominal cavity. The liver trauma was sprayed with medical adhesive. The liver specimen was placed in a homemade retrieval bag (gloves) and the specimen was removed by enlarging the puncture hole below the umbilicus. Two abdominal silicone drainage tubes were placed and drained out of the body through the left and right puncture ports, respectively. The Trocar was withdrawn, the drains were fixed, the small puncture incisions were sutured, and the incisions were bandaged.
The patient’s vital signs were still stable, with a small amount of bleeding. 136 ml of blood was returned via autologous blood transfusion, and the patient was returned to the monitoring room with tracheal intubation after the operation.
The intraoperative specimen was seen by the naked eye: hepatic hemangioma about 10cm×7cm in size, with a non-tumor margin of about 1cm. the resected specimen was shown to the patient’s family and sent to pathology.
Intraoperative specimens were sent to pathology
□1 yes 2 no
Signature of surgeon: Record date May 2011