DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Pelvic pain.
2. Possible endometriosis.
POSTOPERATIVE DIAGNOSES:
1. Pelvic pain.
2. Possible endometriosis.
3. Scarring and possible endometriosis of the appendix.
OPERATION PERFORMED:
1. Laparoscopic ablation of endometriosis.
2. Laparoscopic lysis of adhesions.
3. Laparoscopic appendectomy.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, MD
ANESTHESIA: General endotracheal.
ESTIMATED BLOOD LOSS: Minimal.
SPECIMEN: Appendix.
COMPLICATIONS: None apparent.
CONDITION: Stable to recovery.
OPERATIVE FINDINGS:
1. Normal-appearing uterus.
2. Normal-appearing bladder flap.
3. Normal ovaries and tubes bilaterally.
4. Evidence of old endometriosis and scarring of the posterior cul-de-sac on both the right and left uterosacral ligaments, left greater than right.
5. Minimal endometriosis of the right ovarian fossa.
6. Significant scarring and elongation of the appendix such that the distal tip was twisted around and attached back onto the bowel with possible endometriosis.
7. Normal liver and gallbladder.
DESCRIPTION OF OPERATION: After obtaining informed consent, the patient was brought to the operating room and placed supine on the operating table. General endotracheal anesthesia was administered by the anesthesiologist. The patient was then placed in the dorsal lithotomy position and prepped and draped in the usual sterile fashion for an abdominal and vaginal procedure. A Foley catheter was placed into her bladder, and a HUMI uterine manipulator was placed into the uterus.
Attention was turned to the abdomen where the umbilicus was infiltrated with 0.5% Marcaine. A stab incision was made in the umbilicus and a 5 mm trocar containing the 5 mm 0 degree scope was placed under direct visualization into the peritoneal cavity. A pneumoperitoneum with CO2 gas was created. Two other trocars were then placed under direct visualization, a 5 mm in the right lower quadrant and a 10 mm in the left lower quadrant.
Systematic examination of the pelvis revealed the above findings. The argon beam coagulator was then used to superficially coagulate all areas of endometriosis, keeping the ureter under direct visualization during the ablation process.
At this point, attention was turned to the appendix. The appendix exited from a very long broad stalk from the cecum. It was then twisted around and was encased in peritoneal adhesions and seemed to almost reinsert back onto the bowel itself. Using blunt and sharp dissection without cautery, the appendix was carefully dissected free from all of its adhesions until it could be stretched for its full length. Two Endoloops of 0 Vicryl were then placed around the base of the appendix and separated from each other. The Endo Shears without energy were then used to divide the appendix from the cecum. It was placed into an Endobag, placed through the 10 mm port, and removed through the 10 mm port without spillage.
The entire pelvis was then copiously irrigated and suctioned. All surgical points were examined and found to be hemostatic. The pneumoperitoneum was brought down to a level of 6, and all points were again examined and found to be hemostatic again.
The 10 mm left lower quadrant port had its fascia closed by using a Carter-Thomason fascial closure device and 0 PDS. All instruments were then removed from the abdomen, and pneumoperitoneum was suctioned out of the abdomen. She was returned to the supine position. Her skin incisions were closed with interrupted buried sutures of 4-0 Vicryl. The Foley catheter and HUMI uterine manipulator were removed. She was returned to the supine position and extubated without difficulty. She tolerated the procedure well and was transferred to the recovery room with vital signs stable.
