Circumcision Dictation

SURGEON: Dr. ____

ASSISTANT:

PREOPERATIVE DIAGNOSIS: Phimosis

POSTOPERATIVE DIAGNOSIS: Phimosis

PROCEDURE: Circumcision

FINDINGS:
1. Phimosis

ANESTHESIA: General endotracheal

INTRAVENOUS FLUIDS: IV crystalloid

ESTIMATED BLOOD LOSS: 2 ml

TUBES AND DRAINS: None

SPECIMENS: Foreskin

COMPLICATIONS: None

INDICATIONS FOR PROCEDURE:  The patient is a _ year old male who has a history of phimosis. I discussed the options with the patient who has agreed to have a circumcision. Prior to the procedure today, the patient's history and physical was reviewed. Informed consent was obtained and all questions were satisfactorily answered. The risks and benefits of the procedure including pain, damage to organs, bleeding, pain, infection, complications from anesthesia and other complications were discussed, the patient acknowledged and communicated understanding of these risks and wished to proceed with the procedure.

 

OPERATIVE DETAIL:  The patient was transferred to the operating room and placed on continuous pulse oximetry and cardiac monitoring by anesthesia.  IV antibiotics including 2g of ancef were administered.  IV sedation and general anesthetic were administered.  The patient was in the supine position and prepped and draped in the normal sterile fashion with foreskin retracted and prepped until significant resistance met.  Time out was performed confirming patient, procedure, side, all in the room agreed.  SCDs were on and functioning.  The patient's foreskin was retracted fully and cleaned of any debris and sterilized with iodine and all adhesions were taken down. The distal incision line was marked about half a centimeter proximal to the glans corona. The proximal incision line was marked, being careful to mark to remove all redundant skin without removing too much skin. Both lines were incised using a number 10 scalpel blade, freeing up the subcutaneous attachments of the prepuce skin. Using Bovie electrocautery and scizzors the foreskin was dissected free circumferentially and then using electrocautery with smooth pickups to obtain hemostasis. Excellent hemostasis was obtained. The inner and outer circumcision incisions were then aligned making sure there was no penile torsion. 4-0 chromic was used to close the circumcision incision in an interrupted fashion. All iodine and blood was washed from the patient. There was excellent hemostasis. The needle, sponge and instrument count were correct. Bacitracin was applied to the incision and wrapped with compressive dressing. The patient was awakened by anesthesia and transferred to PACU in stable condition. Patient tolerated the procedure well. Please note that I was present throughout the entire length of the procedure.

 

 

 

PLAN:  The patient will be discharged after meeting anesthesia criteria.  Patient was given given prescriptions for norco and miralax. Discussed with patient the dangers of opioid addiction, how to properly dispose of an expired, unused, or unwanted controlled substance, the fact that delivery of a controlled substance is a felony under Michigan Law, the fact that opiates should not be taken with alcohol, sedatives or other central nervous system acting medications patient should not drive or make important decisions within 6 hours of taking an opiod and discussed the short and long-term effects of exposing a fetus to an opioid. Patient acknowledged and communicated understanding of while not under effects of anesthesia prior to the procedure. The patient understands if there is any nausea, vomiting, fever, chills or develops gross hematuria, persistent or new pain or symptoms to come back to the Emergency Room for evaluation by urologic surgery.Patient will follow up with Dr. in 1-2 weeks.