Operation: Exploratory laparotomy, resection of large left-sided intra-abdominal cyst along with left nephrectomy, closure of enterotomy.
Description of Operative Procedure:
With the patient on the operation room table in the supine position, a 16 French Foley catheter was place for 200 ml amber urine; then, the abdomen was shaved, prepped and draped in the usual sterile fashion. A xiphoid to pubis mid-line abdominal incision was made and carried through into the peritoneum. Retractors were placed, and the cyst was gradually freed from the surrounding tissue with a combination of blunt and sharp dissection. The gonadal vessels were doubly ligated between 0 silk ties and divided in order to free up the medial aspect of the cyst. The transverse mesocolon was incised with the harmonic scalpel in order to expose the left renal fossa. It became obvious that the cyst was intimately associated with the left kidney, and as the latter appeared to be end-stage, we elected to remove the kidney en block with the specimen. Accordingly, the left renal vein was doubly ligated with 0 silk ties and suture-ligated with a 2-0 silk tie prior to dividing. The left renal artery was double=y tied with 0 sild ties and divided, and then the harmonic scalpel was used to divided the remaining attachments; the specimen was then removed.
A 2 cm tear was noted along the antimesenteric border of the distal transverse colon. A small serosal avulsion was repaired by including this in the enterotomy closure with the TA-55 stapler, and then the enterotomy site was imbricated with interrupted 2-0 silk lambert sutures. The abdomen was closed with interrupted 0 vicryl suture and the skin was loosely closed with the stapler.
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