DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Fibroid uterus.
POSTOPERATIVE DIAGNOSIS: Fibroid uterus.
OPERATION PERFORMED:
1. Laparoscopic supracervical hysterectomy.
2. Bilateral salpingo-oophorectomy.
3. Lysis of adhesion.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, MD
ESTIMATED BLOOD LOSS: Less than 100 mL.
FLUIDS: 1700 mL.
OPERATIVE FINDINGS:
1. A 12-week size fibroid uterus.
2. Normal fallopian tubes and ovaries.
3. Normal appendix visualized.
4. No evidence of endometriosis.
5. No gallbladder was visualized.
DESCRIPTION OF OPERATION: The patient was taken to the operating room after proper counsel and consent was obtained. She was prepared and draped in a normal sterile fashion in dorsal lithotomy position.
The speculum was placed in the vagina. The anterior lip of the cervix was grasped with an Allis tenaculum, at which time the HUMI uterine manipulator was placed through the patient’s cervix without difficulty. Uterus was sounded to 12 cm, and attention was then turned to the patient’s umbilical area, at which time a 5 mm incision was made to accommodate a 5 mm port and scope. Once that was done, it was a Step trocar that was used as the initial instrument into the patient’s abdomen.
The abdomen was insufflated with carbon dioxide gas without difficulty. Once the pneumoperitoneum was achieved, the patient’s scope was placed into her abdomen. A quick survey of the abdomen and pelvis revealed a normal-appearing liver with no evidence of the gallbladder. The appendix was also visualized and found to be normal in nature, although slightly adhesed to the sidewall. There was no evidence of endometriosis. The survey of the patient’s pelvis revealed a 12-week size fibroid uterus with normal-appearing ovaries and tubes.
At that time, the procedure began by inserting the secondary port and a third port, 5 mm in size, laterally in the patient’s abdomen. Once the two ports were in place, the tripolar cautery was used to take down the fallopian tubes and infundibulopelvic ligament. Hemostasis was assured with the cautery as well. The round ligaments were also taken down similarly.
Once the vesicouterine peritoneum was identified, it was taken down using tripolar cautery. Hydrodissection was used to separate the bladder from the uterine surface anteriorly. The left side of the uterus was handled in a similar fashion using the tripolar cautery for the infundibulopelvic ligament, round ligament, and vesicouterine peritoneum. Hydrodissection was also used and that side. Hemostasis was assured. The uterine arteries were visualized on both sides, and they were also transected using the tripolar cautery.
Once that was done, the uterine specimen started to blanch. Once both the uterine arteries were transected and hemostasis was assured, at that time a fourth port was placed in the mid umbilical line and it was 15 mm in size to accommodate the morcellator through that port. A 15 mm trocar was placed and the needle tip monopolar cautery was used to transect the uterus from the cervical specimen. Then, the remainder of the cervical stump was cauterized completely using the spatula tip on the cautery. Hemostasis was assured.
Once that was done, the morcellator was introduced into the 15 mm port, and the uterine specimen was morcellated until it was completely removed and the specimens to pathology was uterus, fallopian tubes, and bilateral ovaries. Once the morcellation had completed, an endo-suture was used to suture the anterior and posterior peritoneum around the cervical stump. Hemostasis was assured.
The abdomen was irrigated with warm normal saline and suction was done. All areas were found to be hemostatic. The pneumoperitoneum was released, and all areas were hemostatic still. At that time, the trocars were removed from the patient’s abdomen. The Gore suture introducer was placed into the 15 mm port two times to close the fascial defect there, and the fascial defect was completely closed. After that was done, all instruments were removed. Pneumoperitoneum was released.
The patient was returned to the flattened position, and the skin trocar sites were all closed with 4-0 Vicryl without difficulty. Hemostasis was assured. At the umbilical skin incision, that was closed with a 2-0 Vicryl through full thickness to prevent any future umbilical hernias. Steri-Strips were applied. The patient tolerated the procedure well. Instruments were removed. Sponge, lap, and needle counts were correct x2, and she was taken to the recovery room in stable condition.
