DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Gestation, 39 weeks.
2. Frank breech presentation.
POSTOPERATIVE DIAGNOSES:
1. Gestation, 39 weeks.
2. Frank breech presentation.
3. Left ovarian cyst.
4. Viable female infant.
OPERATION PERFORMED:
1. Primary low transverse cesarean section.
2. Left ovarian cystectomy.
SURGEON: John Doe, MD
ANESTHESIA: Epidural.
INDICATIONS FOR PROCEDURE: The patient is a (XX)-year-old gravida 1, para 0 female, due date of MM/DD/YYYY, who is at 39 plus weeks of gestation with a history of frank breech presentation. The patient was set up for primary low transverse cesarean section after being given treatment options. The patient understood and accepted all of the risks and benefits of the procedure as described to her preoperatively. The procedure was scheduled. Consent was signed preoperatively.
DESCRIPTION OF OPERATION: Following induction of adequate epidural anesthesia, the patient was prepped and draped in normal fashion, in the supine position, for abdominal surgery. After identification of anterior-superior iliac spines, a Pfannenstiel incision was made using a sharp knife and a second knife was used to carry the incision through the subcutaneous tissue and fat and fascial layers. The fascia was elevated using Kochers x2 and the rectus abdominus muscles were dissected from the fascia using blunt and sharp dissection. The recti were separated in the midline and the parietal peritoneum was entered sharply by means of pickups with teeth x2 and Metzenbaum scissors. The peritoneum was cut transversely. Care was taken to avoid injury to the underlying structures. Bladder blade was placed and the vesicouterine fold was then dissected from the lower uterine segment using sharp dissection. The bladder blade was replaced and a low transverse uterine incision was made using sharp knife. Amniotomy was created, clear fluid. The incision was extended by tearing.
The infant was delivered in the left sacroanterior presentation and was delivered and found to be a viable male. Apgars and weight are unknown at this time. The baby’s mouth and nose were suctioned using bulb suction. The cord was clamped x2 and cut. The baby was handed off to the awaiting neonatologist for further resuscitation and evaluation. Cord blood was obtained x1. Vessels were identified x3. Placenta delivered intact. Products of conception were removed using a clean wet lap. The uterus was closed in 2 layers of 0 Vicryl, the first of which being a continuous interlocking stitch, the second of which being a continuous non-interlocking Lembert-type stitch. A few interrupted sutures of 2-0 chromic were necessary for hemostasis. The right tube and ovary were normal. However, the left ovary appeared to be contained a fairly large multiloculated cyst, which was removed by means of Kelly clamps and Metzenbaum scissors. Suture ligatures of 2-0 chromic were placed for hemostasis. These were sent off for pathological evaluation, labeled left ovarian cyst.
Copious amounts of warm normal saline solution were used to irrigate the abdominopelvic cavity with the aide of pool-tip suction. Adequate hemostasis was realized. The rectus abdominus muscles were reapproximated in the midline using several interrupted sutures of 2-0 Vicryl. The fascial layer was closed using #1 Maxon in a continuous non-interlocking fashion stopping at the midline and completing the closure from the contralateral side. Subcutaneous tissue was irrigated. Unipolar Bovie coag was utilized for hemostasis. Skin was closed with a subcuticular stitch of 4-0 Vicryl on a cutting needle. Benzoin and Steri-Strips were also applied. Sponge, lap, needle and instrument counts were all completely correct at the end of the procedure. Estimated blood loss was 800 mL. The patient and infant tolerated the procedure fairly well.
