In laparoscopic surgeyr, the patient was taken to the operating room, placed in supine position, where her anesthetic was induced. Legs were positioned in low Allen stirrups. She was prepped and draped in usual aseptic fashion. She was in and out catheterized. Sponge stick was placed into the vagina and used for retraction. A 5-mm infraumbilical skin incision was made and the Veress needle was advanced where intraperitoneal placement was confirmed with the water drop test. The abdomen was then insufflated with approximately 2.5 L of carbon dioxide gas. The Veress needle was then removed and a 5-mm trocar and sleeve was gently advanced into the abdomen where intraperitoneal placement was confirmed with the laparoscope. The patient was placed in a fair amount of Trendelenburg. We were still unable to visualize pelvis, so we opted to place the suprapubic port. This was done under direct vision via a 5-mm skin incision, utilizing a 5-mm trocar and sleeve, which was advanced into the abdomen under direct vision. Findings are noted above. We opted to remove the suprapubic port under direct vision. There was no bleeding noted and gas was allowed to emanate from the patient's abdomen through both site. The trocar at the umbilicus was removed. The skin incisions were closed using 4-0 Monocryl in a simple interrupted inverted fashion. Both incision sites were injected with 5 cc of 0.25% Marcaine and sterile dressings were applied. The sponge stick was removed from the patient's vagina. Counts were correct x2. At this point, the patient was awakened from her anesthetic. Photo documentation had been performed during the laparoscopy.

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