PREOPERATIVE DIAGNOSIS: Desires permanent sterilization.
POSTOPERATIVE DIAGNOSIS: Desires permanent sterilization.
PROCEDURE: Laparoscopic tubal salpingectomy, Bipolar cautery method
ANESTHESIA: General.
COMPLICATIONS: None.
INDICATIONS FOR SURGERY: A 40 year-old female, multipara who desires permanent sterilization as well as risk reduction for ovarian cancer. The risks of alternatives, bleeding, infection, damage to other organs, and subsequent ectopic pregnancy was explained. Informed consent was obtained.
OPERATIVE FINDINGS: Normal appearing uterus and adnexa bilaterally.
DESCRIPTION OF PROCEDURE: After administration of general anesthesia, the patient was placed in the dorsal lithotomy position, and prepped and draped in the usual sterile fashion. The speculum was placed in the vagina, the cervix was grasped with the tenaculum, and a uterine manipulator inserted. This area was then draped off the remainder of the operative field.
A 5-mm incision was made umbilically after injecting local anesthesia. A 5mm trochar was introduced and the abdomen was insufflated with CO2 gas. Position was confirmed using a laparoscope. Tow other 8 and 5mm ports were placed under direct visualization, after local was injected. The pelvic cavity was examined with the findings as noted above. The right fallopian tube was grasped with the Kleppenger and followed to the fimbriated end. The Bipolar cautery was used to cauterize the surrounding vessels and the fallopian tube was dissected from its surrounding tissue. The same procedure was repeated on the contralateral side. The accessory ports were removed. The abdomen was deflated. The laparoscope and sheaths were removed. The skin edges were approximated with 4-0 vicryl suture in subcuticular fashion. The instruments were removed from the vagina.
All counts were correct at the end of the procedure.
The patient was stable when she was taken to the recovery room as she tolerated the procedure well.