DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Severe pelvic pain.
2. History of pelvic inflammatory disease and pelvic adhesion.
3. Probable left hydrosalpinx.
POSTOPERATIVE DIAGNOSES:
1. Severe pelvic pain.
2. History of pelvic inflammatory disease and pelvic adhesion.
3. Probable left hydrosalpinx.
4. Extensive pelvic adhesion and left hydrosalpinx.
PROCEDURES PERFORMED:
1. Pelvic examination under anesthesia.
2. Total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAHBSO).
3. Lysis of adhesions.
SURGEON: John Doe, MD
ANESTHESIA: General.
ESTIMATED BLOOD LOSS: 100 mL.
COMPLICATIONS: None.
DISPOSITION: The patient was taken to the recovery room in good condition at the end of the procedure.
DESCRIPTION OF OPERATION: The patient was taken to the operating room, where general anesthesia was administered without complication. The patient was placed in the dorsal lithotomy position, and examination under anesthesia revealed a normal-appearing vagina and cervix. Bimanual exam reveals a normal-sized uterus with no right adnexal pathology noted. There was an adnexal mass in the left adnexa of approximately 4-5 cm. The patient was placed in the supine position. She was prepped and draped in the usual fashion.
A Pfannenstiel skin incision was performed and carried down to the fascial layer. The fascia was transected. The rectus muscles were retracted laterally, and the peritoneum was entered under direct visualization. The pelvic cavity was inspected, and there were extensive pelvic adhesions noted. The bowel was packed into the upper abdomen using moist laps. There was a large left hydrosalpinx present with bilateral tubal-ovarian adhesions. The left hydrosalpinx was first freed up using careful sharp dissection. The tube and ovary on the right side were likewise mobilized with sharp dissection. The right round ligament was doubly clamped, cut and tied with 0 Vicryl suture. The visceroperitoneum was dissected free to the midline. The left round ligament was likewise doubly clamped, cut and tied and the visceroperitoneum was dissected free to the midline. The bladder was carefully dissected off the lower uterine segment. The right infundibulopelvic ligament was clamped, cut and doubly tied with 0 Vicryl suture. The left infundibulopelvic ligament was likewise doubly clamped, cut and doubly tied with 0 Vicryl suture. The right uterine vessels and cardinal ligament were doubly clamped, cut and doubly tied with 0 Vicryl suture. The left uterine vessels and cardinal ligament were likewise clamped, cut and doubly tied with 0 Vicryl suture. The bladder was retracted inferiorly. The right uterosacral ligament was clamped, cut and tied with 0 Vicryl suture. This step was repeated until the specimen was mobilized on the right side. The left uterosacral ligament was likewise clamped, cut and tied with 0 Vicryl suture. Again, the step was repeated until the specimen was mobilized on the left side.
The anterior aspect of the vagina was entered with a scalpel and heavy curved scissors were used to remove the uterus, tubes and ovaries, which was sent to pathology for microscopic examination. Angled sutures were placed on either side of the vaginal cuff using 0 Vicryl suture. The vaginal cuff was closed with interrupted figure-of-eight sutures of 0 Vicryl. A thorough search was made to ensure that there was complete hemostasis. The pelvic peritoneum was reapproximated with 0 Vicryl suture. The instruments were removed from the abdomen. The sponge, needle and instrument counts were all correct. The parietal peritoneum was reapproximated with 2-0 Vicryl suture. The rectus muscles were reapproximated with interrupted 0 Vicryl suture. The fascia was closed with 0 PDS suture. The subcutaneous tissue was reapproximated with 3-0 Vicryl suture. The skin was closed with staples. A dry sterile dressing was placed over the incision. The patient was then awoken in the operating room and transferred to the recovery room in good condition.
