DATE AND TIME: [Date and time]
URGENCY: Elective / Non-elective
SURGEON: [Name]
ASSISTANT: [Name / None]
ANAESTHETIST: [Name]
OPERATION: Diagnostic Laparoscopy
ANAESTHETIC: General anaesthesia
ANTIBIOTICS: As per pathology found intra-operatively
DVT PROPHYLAXIS: [Agent / mechanical / Not indicated]
POSITION: Supine with leg extensions. Table tilted as required per pathology. Urinary catheter inserted.
INDICATION:
[Acute: lower abdominal pain — suspected acute appendicitis / ruptured ovarian cyst / perforated peptic ulcer / other acute abdominal pathology not clarified on imaging].
[Elective: investigation of chronic abdominal pain / subfertility / biopsy of suspected intra-abdominal malignancy / staging laparoscopy prior to planned resection].