Right hemicolectomy

Patient and case

1. Name / Age / Sex
2. UHID / IP no. / Ward-Bed
3. Date of surgery / OT no.
4. CaseElectiveEmergency (non-elective)if emergency, state urgency and reason
5. Timesin OT ___ anaesthesia start ___ incision ___ closure ___ out of OT ___

Team

1. Operating surgeonname, designation
2. Assistant(s)
3. Supervising consultantpresent in OT / available / not applicable
4. Steps done by the residentwhole procedure / named steps, under whose supervision
5. Anaesthetist
6. Scrub nurse / circulating nurse

Diagnosis and procedure

1. Pre-operative diagnosis
2. Post-operative diagnosis
3. Procedure planned
4. Procedure performedif different from plan, state why
5. Extra procedure done and reason'none' if none. Only to save life or health if not consented

Consent and safety checks

1. Informed consentGeneralProcedure-specificHigh-riskAnaesthesiain a language the patient understands: language ___ witness ___
2. Site / side markedYesNot applicable
3. WHO Surgical Safety ChecklistSign inTime outSign out
4. Antibiotic prophylaxisdrug, dose, route, time given before incision
5. VTE prophylaxisMechanicalPharmacologicalNot indicated

Risks to explain in the consent for this operation

• anastomotic leak needing re-operation or ileostomy
• bleeding, including from superior mesenteric or middle colic veins
• injury to duodenum, right ureter or gonadal vessels
• intra-abdominal abscess
• wound infection
• prolonged ileus
• incisional hernia
• conversion from laparoscopic to open

Pre-operative details for this operation

1. Indication and diagnosissite of tumour (caecum / ascending / hepatic flexure), biopsy report, or benign indication
2. StagingCT chest-abdomen-pelvis findings, CEA
3. Colonoscopycomplete to caecum? synchronous lesion? tattoo site if laparoscopic
4. Hb and transfusionanaemia corrected; units cross-matched
5. Bowel preparationMechanical preparationOral antibioticsNone
6. Stoma counselling / markingin case an ileostomy is needed

Anaesthesia and position

1. AnaesthesiaGeneral
2. PositionSupineLloyd-Davies (laparoscopic)
3. ApproachOpen, midlineOpen, right transverseLaparoscopicLaparoscopic converted to openif converted, the reason
4. Catheter and NG tubeBothCatheter only

Operative findings

1. Tumoursite, size, fixity, serosal involvement, adherent organs or abdominal wall
2. Liverpalpated: normal / metastases (number, lobes, biopsied?)
3. Peritoneum, omentum, pelvis, ovariesdeposits or ascites
4. Lymph nodesenlarged ileocolic / right colic / middle colic / para-aortic nodes
5. Rest of colon palpatedsecond primary or polyp

Procedure (steps)

1. Incision and explorationincision type and length; order of exploration
2. Wound protection and retractionself-retaining retractor, wound protector
3. Approach to mobilisationLateral to medial along the white line of ToldtMedial to lateral, vessels first
4. Right colon and mesocolon lifted off the retroperitoneumright ureter and gonadal vessels seen and preserved; duodenum and pancreatic head swept back
5. Hepatic flexure mobilised, omentum handledOmentum divided near colonRight half of greater omentum taken with specimen
6. Vascular ligationileocolic, right colic, right branch of middle colic (or middle colic trunk for extended); ligated at origin; SMV and SMA preserved; ligature material or stapler / clips
7. Proximal and distal resection lineslength of terminal ileum; site on transverse colon; margins from tumour
8. Bowel dividedBetween clampsLinear cutting stapler
9. Ileocolic anastomosisStapled side-to-side (functional end-to-end)Hand-sewn end-to-end, one layerHand-sewn end-to-end, two layersHand-sewn end-to-sidesuture material and size or stapler model and cartridges; Cheatle slit if used
10. Anastomosis checkedblood supply of cut ends, tension, patency
11. Mesenteric defect closedsuture used
12. Haemostasis, peritoneal wash, omentum placed over anastomosis

Closure, drains and dressing

1. DrainNoneSuction drain, right paracolic / subhepatic
2. Fasciamass closure, suture material and size, suture-to-wound length ratio
3. SkinStaplesInterruptedSubcuticular
4. Port sites (laparoscopic)10 mm and larger fascia closed

Specimens and implants

1. Right hemicolectomy specimen for HPEterminal ileum, caecum with appendix, ascending colon, part of transverse colon, omentum; orientation marked; nodes; requisition filled
2. Separate specimensliver biopsy, peritoneal nodule, apical node, each labelled
3. Staplers and cartridgesmodel, cartridge length and colour, number fired, stickers pasted

End of procedure

1. Estimated blood lossml
2. IV fluids and blood / products givenfluids (ml); blood: type, units, bag nos.
3. Swab, needle and instrument countCorrectIncorrect: action taken
4. Intra-operative complications / difficultieswhat happened and what was done; 'none' if none
5. Implant stickersNo implantAffixed in case sheet, OT register and for discharge summary
6. Condition at end of surgery / shifted toPACUWardICU/HDU

Post-operative orders

1. Vitals and abdominal examinationpulse, BP, temperature; watch for leak signs
2. NG tuberemove when bowel sounds return, flatus passed and abdomen soft
3. Oral intakeliquids when ileus settles, then diet
4. Drainchart volume and character; remove by about day 5 if serous
5. Fluids and electrolytesinput-output chart, daily electrolytes
6. Catheterremove when mobile and not needing hourly urine output
7. VTE prophylaxisLMWH plus mechanical as per risk; extended course after cancer surgery if unit policy
8. Mobilisation and chest physiotherapy
9. Histopathology follow-upstage, nodes, margins; tumour board referral for adjuvant therapy

Signature

1. Name and designation of person writing note
2. Medical Council registration no.
3. Signature / date / time of writingwrite before the patient leaves recovery