PREOPERATIVE DIAGNOSIS: Desires permanent sterilization.
POSTOPERATIVE DIAGNOSIS: Desires permanent sterilization.
PROCEDURE PERFORMED: Bilateral tubal ligation.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, MD
ANESTHESIA: General endotracheal intubation.
COMPLICATIONS: None.
SPECIMENS REMOVED: Portions of both left and right fallopian tube were sent to pathology.
INDICATIONS FOR OPERATION: This is a (XX)-year-old G6, P3-0-2-3, status post NSVD who desires permanent sterilization. Risks and benefits of the procedure were discussed with the patient, including the risk of failure, about 5 in 1000, increased risk of ectopic pregnancy as well as risks of regret. Consent was obtained for the bilateral tubal ligation, and the patient voiced understanding of the risks and benefits.
FINDINGS: Normal uterus, tubes and ovaries.
DESCRIPTION OF OPERATION: The patient was taken to the operating room for bilateral tubal ligation where she was placed under general endotracheal intubation after a spinal was found to be inadequate.
A small transverse infraumbilical incision was made with a scalpel. The incision was carried down through the underlying fascia to the peritoneum, which was entered. The peritoneum was noted to be free of any adhesions, and the incision was extended with Metzenbaum scissors.
The patient, of note, had had 2 hernia repairs in this area, so the fascia was very thin.
The patient’s left fallopian tube was then identified, brought to the incision and grasped with a Babcock clamp. The tube was then followed out to the fimbria. The Babcock clamp was used to grasp the tube approximately 4 cm from the cornua region and a 3 cm segment of the tube was then ligated with a free tie of plain gut and excised. Good hemostasis was noted, and the tube was returned to the abdomen.
The right fallopian tube was then ligated and a 3 cm segment was excised in a similar fashion. Excellent hemostasis was noted, and the tube was returned to the abdomen.
The peritoneum and fascia were then closed in a single layer using 0 Vicryl, and the skin was closed in a subcuticular fashion using 3-0 Vicryl. The patient tolerated the bilateral tubal ligation well. Sponge, lap and needle counts were correct x2. The patient was taken to the recovery room in stable condition.
