Epic Hyperspace

Jackie Anesthesia

Male, 51 y.o. 11/14/1973

MRN: 202955

Code: Not on file (has ACP docs)

Isolation: None

Physician Surgery, MD

Attending

EXPECTED ADMISSION: 3/4/2025

Patient Class: Hospital Outpatient

Surgery

No active principal problem

Height: --

Last Wt: --

BMI: --

Theator

My Note

Date of Service: 3/5/2025

10:12 AM

Type:

Cosign Required?

After written informed consent was obtained, the patient and operation were correctly identified, and a time out was conducted. Normal general anesthesia was induced and prophylactic antibiotics were administered. The patient was positioned in dorsal lithotomy position.
Preparation for the robotic-assisted radical prostatectomy using the da Vinci Xi system was initiated. A total of 5 laparoscopic working ports were placed for optimal access and visualization.
Adhesiolysis was performed to ensure adequate exposure of the surgical field. Dissection of the Retzius space was then undertaken to gain access to the prostate and surrounding structures. During this phase, the right vas deferens was ligated. The anterior bladder neck was carefully transected, followed by transection of the posterior bladder neck.
Lateral and apical dissection was performed to begin mobilizing the prostate. A hemostatic suture was placed to control bleeding during this phase. The seminal vesicles were identified and dissection of the posterior aspect was completed. The right vas deferens was ligated to fully mobilize these structures. During the dissection, multiple instances of seminal vesicles fluid leak were noted and addressed. The left vas deferens was then ligated to complete this portion of the procedure.
Further lateral and apical dissection was performed to fully mobilize the prostate. A periurethral stitch was placed to provide control during the subsequent steps. The urethra was carefully transected to separate the prostate from the urethral structures. The prostate specimen was then packaged for later removal.
Bilateral lymphadenectomy was performed, including removal of external iliac and obturator nodes. During this phase, multiple hemostatic sutures were placed to control bleeding from the lymphatic vessels. A bladder neck suture was placed to prepare for the anastomosis.
The vesicourethral anastomosis was constructed using a V-Loc suture, creating a watertight connection between the bladder and urethra. A final inspection of the surgical field was performed and the specimen was extracted. Hemostatic powder was applied to ensure complete hemostasis.
Bilateral nerve sparing was successfully achieved throughout the procedure, preserving neurovascular bundles on both sides. All port sites were closed in the usual fashion and were infiltrated with local anesthetic for postoperative pain control. The patient tolerated the procedure well and without complications. All sponge, needle, and instrument counts were correct at the conclusion of this procedure. The patient was extubated and transported to the recovery room in stable condition.