Friday, November 11, 2011

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Laparoscopic supracervical hysterectomy, bilateral salpingectomy, excision of peritoneal endometriosis -OP Report

PREOPERATIVE DIAGNOSIS: Endometriosis.

POSTOPERATIVE DIAGNOSIS: Endometriosis.

OPERATION PERFORMED: Laparoscopic supracervical hysterectomy, bilateral salpingectomy, excision of peritoneal endometriosis.

ANESTHESIA: General endotracheal.

COMPLICATIONS: None.

EBL: Minimal.

PATHOLOGY: Morcellated uterus, right and left fallopian tubes, pelvic peritoneum endometriosis.

FINDINGS:
Patient had about a 10-week size uterus, normal ovaries. She had bilateral tubal cysts. She had a nodule of endometriosis on her left pelvic sidewall overlying the ureter.

OPERATION:
After informed consent was reviewed with the patient, she was taken to the operating room with an IV running. General anesthesia was obtained without difficulty and she was prepped and draped in a modified lithotomy position in the Yellofin stirrups, her hands were tucked at her side, fingers safety padded and checked and her bladder was drained via transurethral Foley catheter.

Attention was turned to her umbilicus where an 11 mm umbilical skin incision was made and a Veress needle was used to insufflate the abdomen with an opening pressure of 3 mm. After the pneumoperitoneum was obtained, an 11 mm optically guided trocar was placed and right and left lower quadrant ports were placed under direct visualization with the findings as noted and photographs were taken. A grasper was placed through the left lower quadrant port, and a harmonic scalpel through the right lower quadrant port. The right triple pedicle and broad ligament were opened down to the internal os of the cervix. The right uterine artery and vein were transected and secured with the harmonic scalpel. Laparoscopic clips were applied.

The instruments were then exchanged in a similar fashion and the left triple pedicle and broad ligament were opened down to the internal os of the cervix. The left uterine artery and vein were identified, transected and secured with the harmonic scalpel, and clips were applied.

Next, a sponge stick was placed in the patient's vagina. A bladder flap was created. The cervix was transected utilizing the harmonic scalpel in a reverse coring technique. The endocervical canal was ablated with the harmonic scalpel.

The uterine corpus was removed through the right lower port using the laparoscopic morcelator. The fallopian tubes were then grasped, elevated, undermined, transected, and secured with the harmonic scalpel and passed off as separate specimens. The patient was given an amp of indigo carmine blue dye. Intraoperative cystoscopy was performed, which showed bilateral ejection of blue dye from both ureters with an intact bladder.

At this point decision was made to end the case. All the instruments were removed. The sites were inspected under low pressures with excellent hemostasis. The trocars were removed. The fascia was closed with 0-Vicryl on a UR-6 needle. The skin was closed with Monocryl and Dermabond. She was taken out of the lithotomy position and taken to the recovery room in excellent condition.

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