Post-op

Operative Notes

Rajesh Kumar · Robotic Low Anterior Resection · OT-1 · 09-Jul-2026

Header

Preop diagnosis

Postop diagnosis

Procedure

Surgeon

Assistants

Anaesthetist

Narrative

Template: Rectal Cancer · v4.1

FINDINGS
• Mid-rectal tumor 8 cm from AV, mobile, no serosal breach.
• Mesorectum intact. No peritoneal deposits or liver metastases.
• Standard TME plane.

STEPS
1. WHO Time-Out completed. Antibiotic prophylaxis Cefuroxime 1.5 g IV given at 07:55.
2. Patient placed in modified lithotomy (Trendelenburg 25°). Padded. Foley catheter.
3. Ports placed: 12 mm camera supra-umbilical; 8 mm robotic ports RUQ, RLQ, LUQ; 12 mm assistant LLQ.
4. da Vinci Xi docked. Console: Dr. Shetty.
5. IMA identified, lymphadenectomy at origin, high tie. IMV divided.
6. Left colon mobilized to splenic flexure with medial-to-lateral dissection.
7. TME performed sharply along holy plane, preserving hypogastric nerves.
8. Distal margin marked 2 cm below tumor; frozen section sent — CLEAR.
9. Specimen extracted via mini-Pfannenstiel using wound protector.
10. Circular stapler 29 mm colorectal anastomosis, air-leak test negative.
11. Diverting loop ileostomy fashioned in RIF.
12. Haemostasis achieved. Pelvic drain placed. Ports closed.

COMPLICATIONS  None.
BLOOD LOSS    380 ml
FLUIDS        1,650 ml crystalloid, 1 unit PRBC
IMPLANTS      Circular stapler 29 mm (Ethicon), Endo GIA 60 purple ×2
SPECIMENS     Rectum with mesorectum (HPE), distal margin (FS — clear), LN packet
DRAINS        Pelvic 24 Fr Robinson
DISPOSITION   SICU-02 for 24h monitoring, epidural analgesia continued.