APPENDECTOMY OPERATION NOTE

Patient: ________________
Identifier: ________________
Date: ________________


PROCEDURE AND TEAM
Procedure performed: ________________
Procedure date and time: ________________
Urgency: ________________
Indication and preoperative diagnosis: ________________
Postoperative diagnosis: ________________
Surgeon and assistants: ________________
Anaesthesia and anaesthetist: ________________
Consent and safety checks: ________________

ACCESS AND FINDINGS
Antimicrobial / VTE prophylaxis record: ________________
Approach, position and access: ________________
Appendix: position and appearance: ________________
Appendiceal base and caecum: ________________
Contamination, collection and other findings: ________________

PROCEDURE
Mesoappendix management: ________________
Base division / stump closure method: ________________
Specimen retrieval and histology: ________________
Suction / irrigation if performed: ________________
Additional procedures / conversion and reason: ________________
Closure, drains and dressing: ________________

COMPLETION AND HANDOVER
Specimens and labels: ________________
Estimated blood loss (mL): ________________
Instrument / swab / needle counts: ________________
Complications and response: ________________
Condition and destination: ________________
Postoperative instructions and responsible team: ________________

Clinician: ________________
Signature: ________________

APPENDECTOMY OPERATION NOTE
FICTIONAL EXAMPLE - NOT FOR CLINICAL USE
Illustrative content only; not a clinical reference.

Patient: FICTIONAL PATIENT
Identifier: DEMO-001
Date: 01 January 2026


PROCEDURE AND TEAM
Procedure performed: Laparoscopic appendectomy (fictional).
Procedure date and time: 01 January 2026, 09:00 (fictional)
Urgency: Urgent
Indication and preoperative diagnosis: Acute appendicitis.
Postoperative diagnosis: Acute appendicitis.
Surgeon and assistants: Dr Demo A; Dr Demo B (fictional)
Anaesthesia and anaesthetist: Technique recorded in the separate anaesthetic chart; Dr Demo C (fictional).
Consent and safety checks: Consent, identity, procedure and site checks documented in the fictional theatre checklist.

ACCESS AND FINDINGS
Antimicrobial / VTE prophylaxis record: Risk assessment and prescribed prophylaxis recorded in the perioperative chart.
Approach, position and access: Supine; laparoscopic access and port sites documented.
Appendix: position and appearance: Inflamed retrocaecal appendix; no visible perforation.
Appendiceal base and caecum: Base and adjacent caecum appeared viable.
Contamination, collection and other findings: Small amount of local fluid; no abscess described.

PROCEDURE
Mesoappendix management: Divided with secure haemostasis.
Base division / stump closure method: Base secured and divided; closure inspected.
Specimen retrieval and histology: Appendix retrieved in a bag and labelled for histology.
Suction / irrigation if performed: Local fluid suctioned; irrigation not performed.
Additional procedures / conversion and reason: None.
Closure, drains and dressing: Port sites closed; no drain; sterile dressings.

COMPLETION AND HANDOVER
Specimens and labels: Specimen details recorded with site and destination.
Estimated blood loss (mL): 20
Instrument / swab / needle counts: Confirmed complete at closure.
Complications and response: None observed during this fictional procedure.
Condition and destination: Transferred to recovery with a documented handover.
Postoperative instructions and responsible team: Individual orders, monitoring, wound review and follow-up to be prescribed by the responsible team.

Clinician: DEMONSTRATION ONLY - NOT SIGNED
FICTIONAL EXAMPLE - NOT FOR CLINICAL USE