DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Dysmenorrhea.
2. Suspect endometriosis.
3. Polycystic ovarian cyst.
POSTOPERATIVE DIAGNOSES:
1. Suspect endometriosis.
2. Polycystic ovarian cyst.
OPERATION PERFORMED:
1. Dilatation and curettage.
2. Hysteroscopy.
3. Laparoscopy.
4. Attempted chromopertubation.
5. Right ovarian drilling.
SURGEON: John Doe, MD
SPECIMENS REMOVED: Endometrial curettings.
BLOOD LOSS: Negligible.
OPERATIVE FINDINGS: The patient had deep, obvious appearing Allen-Masters peritoneal defects on both sides of the uterosacral ligaments. There may have been a tiny clear vesicular lesion in the fundal area on the right side and a small lesion on the serosa of the uterus on the posterior wall, approximately mid position. These were not biopsied. The ovaries were enlarged, especially the right ovary was 2 to 3 times normal size and appeared to be filled with tiny follicular cysts.
DESCRIPTION OF PROCEDURE: The patient was placed on the operating room table in supine position. After successful general endotracheal anesthesia, the patient was placed in dorsal lithotomy position, prepped and draped in usual sterile manner. Bimanual exam was unremarkable, but it was quite limited due to her habitus. The anterior lip of the cervix was grasped with a tenaculum. The uterus was sounded to 6 cm. Cervix was gently dilated to Hegar #6 and a HUMI manipulator was placed within the cervical gutter at 5 cm. The bladder was catheterized. Speculum and tenaculum were removed. A small incision was made at the umbilicus and a disposable Veress needle was inserted into the abdominal cavity uneventfully. Next, 3 liters of CO2 was insufflated and the Veress needle was removed. The sheath and trocar for the 10 mm scope were inserted into the abdominal cavity uneventfully, and the pelvic organs were visualized as noted above. The appendix was normal. There were no perihepatic adhesions. There was no sign of PID. Two 5 mm ports were placed by transilluminating the abdominal wall. Then, under constant direct visualization, through a small skin incision, the 5 mm accessory ports were placed without event. Photographs were taken of the uterus, both ovaries, the appendix, and the Allen-Masters peritoneal defect. Then, a photo was taken of the ovary after ovarian drilling, showing marked reduction in size. The right ovary was grasped with a probe and then with a Harmonic scalpel, using the cutting blade, approximately 15 holes were drilled into the ovary. Each time this was done, a cyst was broken and clear fluid was seen to come out of the hole. Chromopertubation was attempted with indigo carmine through the HUMI; however, it appeared that the cervical seal was not good enough and the dye leaked out the uterus. The tubes, however, looked very healthy. Procedure being complete, all air was allowed to escape and all instruments were removed. The skin incisions were closed with 2-0 nylon mattress sutures. The hysteroscopy was then done by removing the HUMI manipulator, replacing the Graves speculum, regrasping the cervix with a tenaculum. Then, the 5 mm hysteroscope with normal saline distention medium was used. The uterine cavity appeared normal. The hysteroscope was removed and a sharp curette was used. A scant amount of tissue was obtained and sent to pathology. The patient tolerated the procedure well.
