DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Multiple uterine fibroids.
POSTOPERATIVE DIAGNOSIS: Multiple uterine fibroids.
OPERATION PERFORMED:
1. Abdominal myomectomy.
2. Chromopertubation.
SURGEON: John Doe, MD
ANESTHESIA: General.
ESTIMATED BLOOD LOSS: 200.
COMPLICATIONS: None.
OPERATIVE FINDINGS: The patient had a uterus that measured about 11 cm in size, grossly normal-appearing tubes and ovaries bilaterally. However, she had multiple uterine fibroids noted, various sizes, the largest being approximately 5 cm in size, located posteriorly in the lower uterine segment, and multiple smaller fibroids on the anterior and posterior surface.
DESCRIPTION OF OPERATION: The patient was taken to the operating room when anesthesia was found to be adequate for the abdominal myomectomy procedure. She was prepared and draped in a normal sterile fashion, in dorsal lithotomy position. A weighted speculum was placed into the patient’s vagina. The anterior lip of the cervix was grasped with an Allis clamp and a Hulka tenaculum was placed into the patient’s cervical os to accommodate the chromopertubation.
Attention was turned to the patient’s abdomen, at which time a Pfannenstiel skin incision was made with a scalpel and carried down to the underlying fascia with a Bovie. This incision was extended laterally using Mayo scissors. The superior and inferior aspects of this incision were grasped with the Kocher clamps, elevated, and the rectus muscles were dissected off. Access was gained to the peritoneal cavity through a separation of the rectus muscles. At that time, a survey of the upper abdomen revealed no gross abnormalities palpated. The pelvis showed an enlarged multiple fibroid uterus. At that time, the bowel was packed away with large moist lap pads. The Kretschmer retractor was placed into the patient’s abdomen to facilitate visualization.
Once there was proper visualization of the uterus, the anterior surface of the uterus was then evaluated and Pitressin was injected along the myoma surfaces. Once the myomas were isolated, they were grasped with the towel clip and between blunt dissection and needle tip Bovie cautery, that was used to be shelled out of the myometrium completely. Once all the anterior fibroids were removed, each remaining surface was closed in three layers using 2-0 Vicryl in a series of figure-of-eight initially, then a running locked layer of another 2-0 Vicryl, and finally 3-0 Vicryl in the serosal layer. This was done all along the anterior surface of the uterus where each myoma was removed.
Attention was then turned to the patient’s posterior uterus, where in a similar fashion multiple smaller fibroids were handled; however, the largest fibroid being about 5 cm located in the lower posterior uterine segment. That one was also injected with Pitressin solution, incised with the needle tip Bovie cautery, double towel clips were used to grasp this fibroid and to dissect it out of the myometrium. This fibroid was also closed in three layers. Hemostasis was ensured throughout each incision site. Once all fibroids were removed, there were a total of 11 fibroids. The pelvis was then irrigated with warm normal saline and again hemostasis was ensured.
All packs and retractors were removed from the patient’s abdomen. She was flattened out of the Trendelenburg position. The fascia was reapproximated using 2-0 Vicryl x2. The subcutaneous tissue was closed using 3-0 Vicryl suture and finally the skin was closed with staples. Sponge, lap, and needle counts were correct x2 and she was taken to the recovery room in stable condition.
