OPERATION RECORD

Surgeon: ______________________________________ Anesthesiologist: _______________________________________

HOSPITAL: MALABON HOSPITAL AND MEDICAL CENTER
Address: Gov. Pascual Avenue, Brgy. Catmon, Malabon City, Metro Manila
Telephone No:

Date: _______________ Philhealth ( )YES ( ) No HMO:____________________________

Name: ______________________________________ Age: ____________Sex: ________Civil Status: _______

Address: ______________________________________________________Ward: _____________ Bed no: ___
Pre-Operative Diagnosis: ______________________________________________________________________
Post-Operative Diagnosis: _____________________________________________________________________
Surgeon: ______________________________________________ First Assist: __________________________
Anesthesiologist: ______________________________________ Second Assist: _________________________
Anesthetics: _____________________________________________Time Anesthesia began: _______________
Operation Date: _______________________________________ Time Anesthesia ended: _________________
Time Operation began: ________________________(am/pm) Surgical Nurse: ____________________________
Time Operation Ended: _______________________ (am/pm) Circulating Nurse: __________________________
Title Operation(s) performed: ___________________________________________________________________
___________________________________________________________________________________________
__________________________
Specimen to the Laboratory ( ) YES ( ) NO SPECIMEN:______________________________________
Description of procedure and findings:

OPERATION RECORD The information contained within this form is confidential.

Form no. Any breach or improper use is tantamount to violation of the Data Privacy Act of 2012.
 OPERATION RECORD

− Patient supine under general anesthesia

− Asepsis and antisepsis
− Sterile drapes in place
− 10mm umbilical incision carried down to peritoneum
− Left and right anchoring sutures applied at fascia
− 10mm blunt trocar inserted, abdomen insufflated with CO2 at 14mm pressure at high flow rate
− 10mm, zero degrees laparoscope inserted, abdomen inspected: no bleeding, no injuries to bowel/
vessel noted
− Subcostal skin crease incisions done on epigastric, right midclavicular, and right anterior axillary areas
− 10mm, 5mm, 5mm trocars inserted at epigastric, right midclavicular, right anterior axillary respectively
under direct vision
− Gall bladder fundus retracted superiorly and laterally
- Hartmann’s pouch retracted inferiorly and laterally
− Right hepatic crease, common bile duct and first portion of the duodenum landmarks identified
− Cystic artery identified, dissected doubly clipped proximally and singly clipped distally using titanium
clips, then divided
− Gallbladder fundus retracted superiorly and laterally
− Gallbladder initially separated from liver bed using electrocautery
− Gallbladder mobilized and dissected from fundus towards the cystic duct with electrocautery
− Cystic duct identified, dissected and freed
− Cystic duct milked towards the gallbladder then closed with titanium clip
− Cystic duct on the gallbladder side clipped with titanium clip doubly
− Specimen bag introduced into the abdominal cavity; gallbladder bagged
− Appendix grasped with nontraumatic forceps, adhesiolysis done
− Mesoappendix identified, mobilized and secured with Safil 2-0 (patient’s side) and clipped distally with
titanium clip, bagged
− Specimen extracted through umbilical port

Intra-op findings:
− Hemostasis done
− Titanium clips inspected, liver bed inspected for bleeders
− Abdomen inspected: no bleeding, no bile leak, no injury to visceral organs noted
− Trocars removed under direct vision
− Abdomen desufflated
− Umbilical fascia closed using Safil 0 in figure of eight manner and reinforced with horizontal mattress
− Skin incisions closed with inverted simple interrupted subcuticular Safil 4-0 sutures
− Sterile strips and dressing applied
− Patient tolerated the procedure well

_________________________________________________________
SIGNATURE OVER PRINTED NAME OF SURGEON

OPERATION RECORD The information contained within this form is confidential.

Form no. Any breach or improper use is tantamount to violation of the Data Privacy Act of 2012.