Team demographics | 11 | Procedure date | 2 |
| | Report date | 2 |
| | Reported by | 2 |
| | Additional physicians to receive operative report | 2 |
| | Procedure planned | 2 |
| | Procedure performed | 2 |
| | Surgeon | 2 |
| | Assistant(s) | 2 |
| | Level of training of primary operator | 2 |
| | Anesthetic | 2 |
| | Hospital or site of procedure | 2 |
Patient demographics | 10 | Preoperative diagnosis | 2 |
| | Postoperative diagnosis | 2 |
| | Name | 2 |
| | Date of birth | 2 |
| | Age | 2 |
| | Sex | 2 |
| | Medical record number/health number | 2 |
| | Preoperative BMI (kg/m2) | 3 |
| | Previous relevant surgeries | 3 |
| | Past cancer history | 3 |
Preoperative workup and preparation | 12 | Bowel preparation | 2 |
| | Antibiotics in bowel preparation | 2 |
| | Preoperative imaging modality | 2 |
| | Lesion characteristics on imaging | 2 |
| | Preoperative biopsy performed (y/n) | 2 |
| | Pathology results | 2 |
| | Pathology high-risk features | 2 |
| | If lesion is cancer, preoperative staging evaluation | 2 |
| | If lesion is cancer, preoperative TNM stage | 2 |
| | Preoperative endoscopic assessment/findings | 2 |
| | Endoscopy extent | 3 |
| | Prior treatments | 2 |
Lesion characteristics | 9 | Fixed or mobile | 2 |
| | Distance from dentate line (cm) | 2 |
| | Distance from anal verge (cm) | 2 |
| | Relation to rectal folds | 2 |
| | Extent into anal canal (y/n) | 2 |
| | Size (cm) | 2 |
| | Percent circumference | 2 |
| | Appearance | 2 |
| | Location/orientation (anterior, posterior, left, right) | 2 |
Intraoperative procedure details | 20 | Intent of procedure (cure, palliation) | 2 |
| | Patient position | 2 |
| | Platform (TAMIS, TEM) | 2 |
| | Preoperative antibiotics | 2 |
| | DVT prophylaxis | 2 |
| | Skin preparation | 3 |
| | Time-out performed (y/n) | 2 |
| | Lifting with saline or epinephrine | 2 |
| | Defect closure (y/n) | 2 |
| | If defect closed, technique and material used | 2 |
| | Intraperitoneal entry (y/n) | 2 |
| | Completeness of excision | 2 |
| | Closest gross mucosal margin | 2 |
| | How the margins of the specimen are marked | 3 |
| | Piecemeal excision (y/n) | 2 |
| | Unexpected findings or events | 2 |
| | Additional procedures performed | 2 |
| | Complications | 2 |
| | Plane of dissection | 2 |
| | Need for laparoscopy or laparotomy and reasons | 2 |
Postoperative details and plan | 5 | Estimated blood loss (mL) | 2 |
| | Discharge plan | 2 |
| | Reasons if not day surgery | 2 |
| | Postoperative condition | 2 |
| | Additional information/notes (free text) | 2 |