PREOPERATIVE DIAGNOSES:
1. Endometrial hyperplasia.
2. History of breast cancer.
POSTOPERATIVE DIAGNOSES:
1. Endometrial hyperplasia.
2. History of breast cancer.
3. Fibroid uterus.
OPERATION PERFORMED: TAHBSO.
SURGEON: John Doe, MD
ANESTHESIA: General endotracheal.
COMPLICATIONS: None.
EBL: 100.
URINE OUTPUT: 300 mL, clear urine.
FLUIDS: At the end of the procedure, 1500 mL crystalloid.
FINDINGS: Exam under anesthesia was not performed.
OPERATIVE FINDINGS: Approximately 8-week size uterus with normal tubes and ovaries bilaterally. Normal-appearing cervix. Uterus had a small right lower segment approximately 3 cm submucosal fibroid.
SPECIMEN: Sent to pathology.
DESCRIPTION OF OPERATION: The risks, benefits, indications, and alternatives to the procedure, TAHBSO, were reviewed with the patient in detail, and informed consent was obtained for the TAHBSO. The patient was taken to the operating room and placed in the supine position. She was given general endotracheal anesthesia and prepped and draped in the normal sterile fashion.
A Pfannenstiel incision was made and carried out to the underlying layer of fascia, which was incised bilaterally and extended with curved Mayo scissors. Muscles were separated in the midline, and peritoneum was entered bluntly and was extended. The pelvis was examined and the findings were noted above. An O’Connor-O’Sullivan retractor was placed into the incision. Bowel was packed away with moist laparotomy. Two Kelly clamps were placed on the cornua, used for retraction. The round ligaments on the right side were clamped, transected, and suture ligated with 0 Vicryl. The anterior leaf of the broad ligament was incised along the bladder reflection, and the bladder was dissected off with a sponge stick. Infundibular ligaments on the right side were then doubly clamped, transected, and suture ligated behind the ovary. This was then done on the patient’s left side. Hemostasis was obtained bilaterally. The uterine arteries were then skeletonized bilaterally, clamped with Heaney clamps, transected, and suture ligated with 0 Vicryl. Hemostasis was assured.
Uterosacral ligaments were then clamped on both sides, transected, and suture ligated in a similar fashion. The cervix and uterus were then amputated using scissors. Vaginal cuff angles were closed and transfixed to the lateral cardinal and uterosacral ligaments. The remainder of the vaginal cuff was then closed with a series of interrupted figure-of-eight sutures with 0 Vicryl. Hemostasis was obtained. The pelvis was irrigated copiously with warm normal saline. Laparotomy sponges and instruments were removed from the abdomen. The fascia was closed with running 0 Vicryl. Hemostasis was obtained. The skin was closed with staples. Sponge, lap, and needle counts were correct x2. The patient was taken to the PACU in stable condition.
