PREOPERATIVE DIAGNOSIS: Pelvic pain with ovarian cyst.
POSTOPERATIVE DIAGNOSIS: Pelvic pain with ovarian cyst.
PROCEDURE PERFORMED: Bilateral salpingo-oophorectomy.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, MD
ANESTHESIA: General endotracheal anesthesia.
COMPLICATIONS: None.
ESTIMATED BLOOD LOSS: 25 mL.
FLUIDS: Two liters LR replaced.
URINE OUTPUT: 340 mL clear urine at the end of the procedure.
FINDINGS: Examination under anesthesia: Ovaries and fallopian tubes were identified bilaterally and found to be grossly normal. There were a few adhesions present. Uterus was surgically absent as noted by history.
DESCRIPTION OF PROCEDURE: The patient was taken to the operating room for bilateral salpingo-oophorectomy where general anesthesia was obtained without difficulty and found to be adequate. The patient was placed in the supine position, prepared and draped in the normal sterile fashion after an examination under anesthesia was completed.
Pfannenstiel skin incision was made approximately 2 cm above the symphysis pubis at the site of her prior scar. This incision was extended sharply using the scalpel to the rectus fascia. The fascia was then incised bilaterally with curved Mayo scissors, and the muscles of the anterior abdominal wall were then separated in the midline by sharp and blunt dissection.
The peritoneum was grasped between two hemostats, elevated and entered sharply with the scalpel. The remainder of the peritoneum was stretched manually. Pelvis was examined with the findings as noted above. A protractor retractor was placed into the incision, and the bowel was packed away with four moist laparotomy sponges.
The round ligament on the right was visualized and grasped using a Kelly clamp. It was transected using the LigaSure and then cut using the Metzenbaum scissors anteriorly for the broad ligament. It was then further dissected with the Metzenbaum scissors along the remainder of the bladder reflection. The infundibulopelvic ligament was also well visualized and transected using the LigaSure with triple attempts to assure good hemostasis. This was well visualized.
The specimen containing the right ovary and tube was freed from the pelvis and sent to pathology. Similarly, the left ovary and tube were removed using the LigaSure device, and good hemostasis was noted. The left ovary and tube were also sent to pathology. Residual small bleeding on the round ligament was resolved using the Bovie. Excellent hemostasis was noted.
One small omental adhesion was manually freed. The edge of the omental adhesion was then tied using a figure-of-eight stitch, and hemostasis was noted. The pelvis was irrigated copiously with warmed normal saline. The uterus was surgical absent as noted above.
All laparotomy sponges and instruments were removed from the abdomen. The peritoneum was closed using a running stitch. Hemostasis was assured. A single interrupted stitch was used to reapproximate the rectus muscles. The fascia was then reapproximated using 0 PDS in a running fashion.
Sponge, lap, needle and instrument counts were correct. The subcutaneous fat was then reapproximated using interrupted stitches of 0 Vicryl. The skin was then closed using 4-0 Monocryl in a subcuticular stitch. The incision was then dressed. Again, all counts were correct. The patient was taken to the PACU in stable condition having tolerated the bilateral salpingo-oophorectomy well. This patient received preoperative antibiotics of Flagyl and Ancef.
