DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Complex right ovarian or adnexal mass.
2. Pelvic pain.
POSTOPERATIVE DIAGNOSIS:
Right ovarian cyst, suspected to be dermoid.
OPERATION PERFORMED:
Laparoscopic ovarian cystectomy, right.
SURGEON: John Doe, MD
ANESTHESIA: General.
OPERATIVE FINDINGS:
1. Bimanual examination revealed an anteverted 6-week size uterus with a right adnexal mass palpated that was detected to be mobile.
2. Right ovarian cyst, appearing to be dermoid in appearance.
3. Normal-appearing uterus, left ovary, tubes and liver.
4. There were adhesions noted extending from the left colon to the left pelvic sidewall and a strand of adhesion extending from the small bowel to the anterior abdominal wall.
SPECIMEN SENT:
Cyst wall and right ovarian cyst.
ESTIMATED BLOOD LOSS:
25 mL.
IV FLUIDS:
2000 mL of lactated Ringer’s.
URINE OUTPUT:
85 mL.
INDICATIONS FOR OPERATION:
The patient is a (XX)-year-old G1 admitted with a diagnosis of complex right adnexal mass measuring about 8 x 6.5 cm. The mass had been causing pain for about 3 to 4 weeks. The patient had been referred for preoperative evaluation due to history of leukopenia and was given preoperative clearance. All risks and benefits of laparoscopic ovarian cystectomy, right, had been discussed with the patient in clinic. All her questions were answered. The patient was taken to the operating room in stable condition.
DESCRIPTION OF OPERATION:
The patient was taken to the OR where she was placed under general anesthesia without difficulty for laparoscopic ovarian cystectomy. She was then prepped and draped in the usual sterile fashion and placed in the dorsal lithotomy position. A preoperative bimanual examination revealed findings as above.
Attention was turned to the vagina, where a weighted speculum was placed in the vagina and the anterior lip of the cervix was grasped using a single-toothed tenaculum. The Cohen cannula was then inserted through the cervix without difficulty and the weighted speculum was removed. The bladder had been drained with a Foley catheter that was placed in the bladder.
Attention was then turned to the abdomen where an approximately 10 mm skin incision was made in the umbilical fold. Entry into the peritoneum was done using the open method. The fascia was identified and incised and the fascia and peritoneum were entered using a blunt Kelley clamp.
At this time, the 10 mm trocar was placed through the umbilical incision and confirmation of intraabdominal placement was confirmed under direct visualization by the camera. The abdomen was insufflated using approximately 4 liters of CO2 gas.
At this time, the second incision was made using a 5 mm incision and 5 mm trocar in the left lower quadrant and the third trocar was inserted also using a 5 mm incision in the right lower quadrant.
Examination of the pelvis revealed findings as above. At this time, the left ovarian cyst appeared to be normal. Attention was turned to the right ovary which was mobilized out of the pelvis. An approximately 5 to 6 cm incision was made along the ovary using electrocautery.
At this point, it was dissected initially using hydrodissection and using blunt dissection. Entry into the cyst was created using the electrocautery. Suction was used to drain scant fluid at this time from the cyst. However, with suction, a large globular piece of cyst was obtained that appeared to be coagulated blood with congealed fat that appeared to be consistent with a dermoid. This was placed in the anterior cul-de-sac.
At this time, the cyst wall was identified and was removed using blunt dissection with countertraction. The ovarian bed was then irrigated and dried. There was slight oozing noted near the edge of the ovary, obtained hemostasis using electrocautery. The pelvis was then irrigated, and once hemostasis was assured, the Endo Catch bag was placed through the 10 mm port and the cyst wall components as well as the right ovarian cyst were placed in the Endo Catch bag and removed through the 10 mm incision without difficulty.
At this time, the pelvis was again copiously irrigated and dried. Hemostasis was assured. A Seprafilm was applied to the right ovary for adhesion prevention. At this time, all instruments were removed under visualization. The 10 mm umbilical incision was closed using 2 interrupted stitches of 2-0 Vicryl sutures and the skin was closed using interrupted stitches of 4-0 Monocryl suture. Steri-Strips were placed after closure with 4-0 suture in the lateral ports.
All instruments were removed. There was slight oozing noted at the site of the single-toothed tenaculum insertion, obtained hemostasis using ring forceps pressure and Monsel solution. Once all instruments were removed, the patient was cleaned. The patient tolerated the laparoscopic ovarian cystectomy well without complications and was taken to the recovery room in stable condition.
