PREOPERATIVE DIAGNOSIS: Pelvic mass.
POSTOPERATIVE DIAGNOSIS: Right ovarian fibroma.
OPERATION PERFORMED: Bilateral salpingo-oophorectomy.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, MD
ANESTHESIA: General endotracheal anesthesia.
ESTIMATED BLOOD LOSS: Minimal.
CONDITION: Stable to the recovery room.
DRAINS: Foley to gravity.
COMPLICATIONS: None.
SPECIMENS: Right tube and ovary (frozen section), left tube and ovary.
INDICATIONS FOR OPERATION: This (XX)-year-old woman was referred with a solid mass of the right ovary. She is status post transvaginal hysterectomy for benign disease.
DESCRIPTION OF OPERATION: After an adequate level of general endotracheal anesthesia was obtained, bimanual rectovaginal exam was performed revealing a right ovary that seems to be adherent to the right pelvic sidewall. The left adnexa are not appreciated as abnormal. The patient was prepped and draped for an abdominal procedure.
A midline vertical incision was made in the skin and extended from the symphysis pubis to the umbilicus. Subcutaneous fat and fascia were divided. Underlying peritoneum was entered. A small amount of fluid was aspirated and submitted for cytologic study. A Bookwalter retractor was placed into the operative field. The right ovary was elevated up out of the pelvis, where it had some filmy adhesions adhering it to the right pelvic sidewall. The surface overall was smooth. It was a very hard mass measuring approximately 10 x 8 x 9 cm. It also had undergone torsion x3 with clot appreciated in the vessels of the infundibulopelvic ligaments, which were markedly tortuous and varicosed.
The right ureter was identified. The right infundibulopelvic ligament and meso-ovarian ligaments were clamped across in a series of steps with the LigaSure. The tissue was coagulated and divided. This specimen was passed to Pathology for assessment. In the meantime, the left ovary, which was atrophic and normal in appearance, was elevated, and the meso-ovarian ligament and infundibulopelvic ligament were both clamped across after identification of the course of the left ureter. This pedicle was coagulated and divided and submitted for pathology permanent sections. After there was a confirmation of the right ovary being a fibroma, the pelvis was irrigated. No bleeders were identified. The lap pads were removed. The intestines were allowed to return to the normally occurring location.
The abdomen was closed with looped 0 PDS on the fascia. The subcutaneous tissues were irrigated and reapproximated with 3-0 Vicryl. The skin edges were reapproximated with staple. Sponge, needle, and instrument counts were reported as correct, and the patient was transferred to the recovery room in stable condition.
