DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Desires permanent sterilization.
POSTOPERATIVE DIAGNOSES:
1. Desires permanent sterilization.
2. Large fibroid uterus.
OPERATION PERFORMED: Laparoscopic bilateral tubal fulguration.
SURGEON: John Doe, MD
ANESTHESIA: General.
ESTIMATED BLOOD LOSS: Less than 10 mL.
COMPLICATIONS: None.
DRAINS: None.
PATHOLOGY: None.
OPERATIVE FINDINGS: Large uterus with 6.5 cm fibroid, posterior fundal. Normal-appearing tubes and ovaries bilaterally. There is a small adhesion anteriorly to the anterior abdominal wall, which was reduced. No other pathologic finding.
DESCRIPTION OF OPERATION: The patient was taken to the operating room after an adequate level of general anesthesia and placed in the dorsal lithotomy position. The patient was prepped and draped in the usual sterile fashion. The bladder was emptied using red rubber catheter. The Hulka uterine manipulator was placed without complication.
Attention was then turned to the laparoscopic portion of the procedure. Marcaine 0.25% with epinephrine was instilled in the infraumbilical region. A 1 cm incision was then made with the scalpel, and the nonbladed trocar was advanced into the abdominal cavity without complication. Correct placement was noted with the laparoscope, and the abdomen was insufflated to a pressure of 15 mmHg. After evaluation of the pelvis with the above findings, the bipolar Kleppingers were placed through the operative channel of the laparoscope, and cautery of the tube was performed with approximately five burns per side, approximately 1.5 cm from the cornual end of the tube. This was done bilaterally without complication. The small adhesion that was on the anterior surface of the uterus to the anterior abdominal wall was taken down sharply with laparoscopic scissors without incident. Good mobility of the uterus was noted with that performed.
No other significant pathology was noted, and therefore, the procedure was completed. The laparoscope was removed and the abdomen deflated of carbon dioxide. The introducer was removed, and the skin was closed with 4-0 Monocryl in a subcuticular interrupted stitch. The patient tolerated the procedure well with no major complications and was taken to the recovery room in good condition.
