DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Endometrial hyperplasia.
2. Stress incontinence.
POSTOPERATIVE DIAGNOSES:
1. Endometrial hyperplasia.
2. Stress incontinence.
OPERATION PERFORMED:
1. Total abdominal hysterectomy.
2. Burch colposuspension with cystoscopy.
SURGEON: John Doe, MD
DESCRIPTION OF OPERATION: This (XX)-year-old patient was prepped and draped in the dorsal lithotomy position under general anesthesia. A Foley catheter was in the bladder and the patient was grounded. A Pfannenstiel incision was made and the layers of abdominal wall taken down in the usual fashion. The space of Retzius was easily developed with the operator’s hands prior to entering the abdominal cavity. Cooper ligaments were visualized bilaterally.
After entering the abdominal cavity, palpation of the loops of bowel, omentum, liver, gallbladder, kidneys bilaterally revealed normal findings. The patient was placed in the Trendelenburg position and the inspection and palpation of the pelvis revealed normal uterus, normal ovaries bilaterally. The self-retaining retractor was placed in and the bowel was packed away with damp sponges. The uterus was elevated with Kocher and round ligaments were cut, divided and suture ligated bilaterally. The leaves of the broad ligament were incised anteriorly and posteriorly, and the ureters were visualized bilaterally without difficulty. The ovarian pedicles were clamped, divided and suture ligated. After the parauterine tissue was skeletonized, the successive pedicles were taken on both sides of the uterus. These were clamped, divided and suture ligated until vaginal cuff was entered. The uterus was removed and the vaginal cuff was closed with a running interlocking suture.
The pelvis was irrigated and suctioned and excellent hemostasis was obtained. All the instruments and sponges were removed and abdominal peritoneum was closed with a running suture. With the operator’s hand in the patient’s vagina, the space of Retzius was further developed until the lateral wall of the anterior vaginal wall was seen and the bladder rollback was shown bilaterally. Prolene sutures were placed in the anterior vaginal wall lateral to the urethra and the bladder wall twice on each side. These were attached to the Cooper ligaments on that same side. A similar procedure was performed on the patient’s left side. The bleeding was minimal.
Cystoscopy was carried out next. The Foley catheter was removed and a cystoscope was easily passed through the urethra and the bladder was visualized. The urine was noted to be coming out from both ureteric orifices and inspection of the bladder walls revealed no bleeding and no sutures. Elevation of the sutures attached to the Cooper ligaments by the operator’s assistant showed elevation and closing of the urethra. The cystoscope was removed, and subsequently, the sutures were tied to no tension. Bleeding was minimal. Because of the previous oozing in the right space of Retzius, Gelfoam was placed there.
All the instruments and sponges were removed and fascia was closed with a running suture. Subcutaneous fat was reapproximated with running suture. Staples and Steri-Strips were used to close the skin. Estimated blood loss of the procedure was approximately 200 mL. There were no complications. The patient left the postanesthetic room in a stable condition. The instrument, needle and sponge counts were correct x2 at the end of the procedure.
