DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Complex pelvic mass, elevated CA-125, rule out ovarian cancer.
2. Ventral hernia.
POSTOPERATIVE DIAGNOSIS:
Fibroma of the right ovary with torsion.
OPERATION PERFORMED:
1. Total abdominal hysterectomy, bilateral salpingo-oophorectomy.
2. Repair of ventral hernia.
SURGEON: John Doe, MD
ANESTHESIA: General endotracheal.
ESTIMATED BLOOD LOSS: 150 mL.
DRAINS: Foley GU bag.
PROCEDURE FINDINGS: The patient had a 10 cm fibroma of the right ovary with torsion, a small amount of ascites upon opening the abdomen. The small and large bowel palpated normally. The patient is status post cholecystectomy and has a 2 to 3 cm hernia at the medial margin of her cholecystectomy incision.
DESCRIPTION OF PROCEDURE: The patient was taken to the operating room and placed in the supine position, given satisfactory general endotracheal anesthesia. Her legs were placed in Allen stirrups. The abdomen, perineum, and vagina were prepped with Betadine and draped in the usual sterile fashion. Foley catheter was inserted sterilely. A vertical incision was made from the symphysis pubis to the umbilicus. The subcutaneous tissue was divided sharply to the fascia. The fascia was split in the midline. The rectus muscles were separated. The peritoneum was entered. Washings were obtained from the pelvis and right upper quadrant. The Bookwalter retractor was placed, and bowel was packed up with moist laps.
Kocher clamps were placed across the uteroovarian pedicles. The round ligament was suture ligated and divided. The retroperitoneal space was opened lateral to the infundibulopelvic ligaments. The ureter and major vessels were identified. The IP ligaments were doubly ligated with locking Hem-o-lok clips. The adnexa were excised. The bladder flap was taken down with Bovie cautery and Metzenbaum scissors. The uterine vessels were clamped, cut, and Heaney ligated with 2-0 Vicryl. The bladder was further dissected. The cardinal ligaments were then clamped, cut, and Heaney ligated with 2-0 Vicryl. Right-angled Zeppelin clamps were brought across the uterosacral ligaments and the vaginal corners. The uterus was cut away. The vaginal corners were suture ligated with 2-0 Vicryl, and the vagina was irrigated and closed with figure-of-eight 2-0 Vicryl sutures. Hemostasis was achieved in the peritoneum with pickups, hemoclips, and Bovie cautery.
Frozen section returned benign. Seprafilm was placed on the right and left pelvic sidewalls of the anterior and posterior cul-de-sac. All laps and retractors were removed. Sponge and needle counts were correct.
Two large Richardson retractors were used to elevate the anterior abdominal wall. A 2 cm hernia could be palpated at the medial margin of the cholecystectomy incision. This was closed from the peritoneal side with 2 large figure-of-eight #2 Prolene sutures effectively closing the fascial defect. Hemostasis was excellent.
Seprafilm was then placed across the anterior abdominal wall. The peritoneum and fascia were closed with running #2 Prolene beginning at each end of the incision, proceeding towards the midline, tying together and inverting the knot. The subcutaneous tissues were irrigated. Bleeding points were cauterized. The skin was closed with subcuticular absorbable clips. Steri-Strips were applied. The patient tolerated the procedure without difficulty. She was awakened and taken to recovery in stable condition.
