DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Right tubal ectopic pregnancy.
POSTOPERATIVE DIAGNOSES:
1. Right tubal ectopic pregnancy.
2. Hemoperitoneum.
3. Pelvic adhesions.
OPERATION PERFORMED:
1. Laparoscopic right linear salpingostomy.
2. Lysis of pelvic adhesions.
SURGEON: John Doe, MD
ANESTHESIA: General endotracheal.
IV FLUIDS: Crystalloids.
ESTIMATED BLOOD LOSS: 10 mL.
INDICATION FOR PROCEDURE: The patient was seen by Dr. Jane Doe, who performed informed consent regarding the risks, benefits, and alternatives of the planned procedure, including the potential for excision of the entire fallopian tube versus a linear salpingostomy. The patient strongly desired a linear salpingostomy, particularly if the left fallopian tube was damaged.
INTRAOPERATIVE FINDINGS: Cervix without induration. Uterus slightly retroverted, top normal size, somewhat boggy, with fullness in the right adnexa but an unremarkable left adnexa. Laparoscopic findings included omental adhesions underneath the umbilicus and down to the suprapubic region. The omentum was attached to the fundus of the uterus. The left fallopian tube appeared to have been transected at one time, as the distal portion including the fimbria was completely absent, and there was a truncated end to the tube at about the ampullary portion. The right fallopian tube was markedly swollen with some blood dripping from the fimbria; although, the fimbria appeared grossly normal. There were two benign paratubal cysts, and the fallopian tube itself was not tortuous, but there were some filmy adhesions between the tube and the right ovary. Right and left ovaries were grossly normal, as was the uterus itself, retrocervical area, and right and left ureters. Appendix was grossly normal. No evidence of trauma to the intestines, ureters, or other structures, and the tube was hemostatic at the end of the case.
DESCRIPTION OF OPERATION: The patient was taken to the operating suite, given general endotracheal anesthesia, and was then prepped and draped in the usual sterile fashion in the dorsal lithotomy position in the Allen stirrups. A sponge stick was placed in, and the bladder was emptied with a catheter. Marcaine was injected in the umbilicus and later on to the left and right lower quadrants and then a 5 mm stab wound was made in the umbilicus, and an Optiview was placed under extreme care into the peritoneal cavity without trauma to the underlying organs. Carbon dioxide was insufflated and then a right lower quadrant port was placed, and the laparoscope was moved into the right lower quadrant. The left lower quadrant port was placed under direct visualization and expanded to a 10 mm later in the case. The Harmonic scalpel was used to excise the omental adhesions off the fundus of the uterus and to remove some of the adhesions from the anterior abdominal wall in order to obtain exposure to the right lower quadrant. This was done uneventfully.
The fallopian tube was injected with dilute Pitressin solution, and the Harmonic scalpel was used to perform a linear incision along the fallopian tube so that the 10 mm grasping device could be used to remove the placental sac and enclosed fetus, which grossly appeared about 6 to 7 weeks in size, from the fallopian tube. This was removed in total through the port and sent for permanent pathologic evaluation. The fallopian tube was irrigated copiously. A few small placental remnants were removed, and there did not appear to be any remaining placental tissue. The edges were coagulated using the Kleppinger forceps, in the tube, and the pressure was dropped. Hemostasis was assured. The tube was left to heal by secondary intention. Copious irrigation was undertaken to remove all blood and debris and then Interceed was placed over the fallopian tube, it was placed back in the cul-de-sac, and there was still excellent hemostasis.
Therefore, carbon dioxide was released after the instruments were removed under direct visualization and the incisions were sewn with interrupted 2-0 Vicryl for the fascia and running subcuticular 4-0 Vicryl for the skin. Steri-Strips were applied. The sponge stick and catheter were removed, and the patient was taken from the operating suite having tolerated the procedure without complications with sponge and instrument counts correct.
