rockylopez
Networker
Hello Fellow Coders. Any input is appreciated. I am gearing towards 59151 for the right ruptured ectopic preg but i am stuck with the left ovarian drainage. I found 58805?
Preoperative Diagnosis: Free fluid, suspected ruptured ectopic pregnancy vs hemorrhagic cyst
Postoperative Diagnosis: Right ruptured ectopic pregnancy, left ovarian hermorrhagic cyst
Procedure Performed: Laparoscopic right salpingectomy, left ovarian cyst drainage
Anesthesia:General anesthesia
Complications: none
Estimated Blood Loss: 15cc (hemoperiteneum), 50 cc total
Blood Products: None
Fluids: 650 mls.
Urine: 100 mls, clear
Specimen: Right fallopian tube with POCs, left ovarian cyst contents
Findings: 15 cc hemoperitenum of dark red blood.The right fallopian tube was grossly enlarged, ruptured with active bleeding noted and was nonsalvagable. Products of conception were protruding from right fallopian tube fimbriated end. The left ovary had a and large hemorrhagic cyst that was found to be ruptured and bleeding, the right ovary appeared normal with no evidence of dermoid
Procedure in detail:
The patient was taken to Operating Room, was identified and the procedure verified as the procedure above. A Time Out was held and the above information confirmed. General anesthesia was obtained without difficulty. The patient was placed in dorsal lithotomy position with Allen stirrups with knees bent at 30-degree angles. The patient was prepared and draped. A straight foley catheter was inserted, and the bladder emptied.
A uterine manipulator was introduced into the vagina. 4 cc of Marcaine was injected at just below the umbilicus and a vertical skin incision was made across the umbilical folds. The Veress needle was placed and a 5 mm Optiview trochar and laparoscope was carefully introduced into the abdomen however intra-abdominal placement was not confirmed with the laparoscope. After 2 attempts attention was turned to Palmer's point. Intra-abdominal placement of the Veress needle at Palmer's point was attempted however was unsuccessful after 2 times. Attention was then turned back to the umbilical port and an open technique was used to enter the abdomen. 0 Vicryl was used to tag the fascia on either side and a 12 mm trocar was placed at the umbilicus. A 5 mm trocar was inserted into the left lower quadrant under direct laparoscopic visualization using 4 cc Marcaine prior to making horizontal incision along the skin line.
An intra-abdominal survey revealed hemoperitoneum. The left fallopian tube appeared normal. The right fallopian tube appeared enlarged and was bleeding and appeared nonsalvageable. The right ovary appeared normal. The left ovary appeared to have an enlarged hemorrhagic cyst that was actively bleeding. The decision was made to proceed with right salpingectomy. An additional 5 mm trochar was inserted in the right upper quadrant for a surgeon's port under direct laparoscopic visualization using 4 cc Marcaine prior to making horizontal incisions along the skin lines. Trendelenberg position was obtained to facilitate pelvic exposure. The right fallopian tube was elevated away from the pelvic sidewall with an atraumatic grasper. The fallopian tube proximal to the implantation site was clamped, coagulated, and transected with the harmonic. The mesosalpinx was serially coagulated and cut. The tube and product of gestation were completely freed and retrieved using an Endo Catch bag. Endocatch device was introduced thru the 12 mm trochar and advanced near the specimen under direct vision of the laparoscope. The specimen was placed in the bad and retrieved. Attention was then turned to the left ovary. The left ovarian hemorrhagic cyst was found to be ruptured. Using the suction device the cyst was drained and contents and cell removed from the cyst. Remaining cyst was found to be friable. Monopolar cautery was used to achieve hemostasis. Arista was placed within the ovarian cyst and surrounding areas to obtain excellent hemostasis.
The abdomen and pelvis were thoroughly inspected. Good hemostasis noted at resection sites. The 5 mm trocars were withdrawn. The 12 mm trochar and laparoscope was then withdrawn and the pneumoperitoneum was released. The fascia was closed at the 12 mm port using the previously placed 0 Vicryl sutures. The uterine manipulator was removed from the vagina. Correct instrument count was confirmed. The skin incisions were closed with 4-0 Monocryl using running stitches and were covered with Dermabond. The patient was taken to the recovery room in stable condition.
Preoperative Diagnosis: Free fluid, suspected ruptured ectopic pregnancy vs hemorrhagic cyst
Postoperative Diagnosis: Right ruptured ectopic pregnancy, left ovarian hermorrhagic cyst
Procedure Performed: Laparoscopic right salpingectomy, left ovarian cyst drainage
Anesthesia:General anesthesia
Complications: none
Estimated Blood Loss: 15cc (hemoperiteneum), 50 cc total
Blood Products: None
Fluids: 650 mls.
Urine: 100 mls, clear
Specimen: Right fallopian tube with POCs, left ovarian cyst contents
Findings: 15 cc hemoperitenum of dark red blood.The right fallopian tube was grossly enlarged, ruptured with active bleeding noted and was nonsalvagable. Products of conception were protruding from right fallopian tube fimbriated end. The left ovary had a and large hemorrhagic cyst that was found to be ruptured and bleeding, the right ovary appeared normal with no evidence of dermoid
Procedure in detail:
The patient was taken to Operating Room, was identified and the procedure verified as the procedure above. A Time Out was held and the above information confirmed. General anesthesia was obtained without difficulty. The patient was placed in dorsal lithotomy position with Allen stirrups with knees bent at 30-degree angles. The patient was prepared and draped. A straight foley catheter was inserted, and the bladder emptied.
A uterine manipulator was introduced into the vagina. 4 cc of Marcaine was injected at just below the umbilicus and a vertical skin incision was made across the umbilical folds. The Veress needle was placed and a 5 mm Optiview trochar and laparoscope was carefully introduced into the abdomen however intra-abdominal placement was not confirmed with the laparoscope. After 2 attempts attention was turned to Palmer's point. Intra-abdominal placement of the Veress needle at Palmer's point was attempted however was unsuccessful after 2 times. Attention was then turned back to the umbilical port and an open technique was used to enter the abdomen. 0 Vicryl was used to tag the fascia on either side and a 12 mm trocar was placed at the umbilicus. A 5 mm trocar was inserted into the left lower quadrant under direct laparoscopic visualization using 4 cc Marcaine prior to making horizontal incision along the skin line.
An intra-abdominal survey revealed hemoperitoneum. The left fallopian tube appeared normal. The right fallopian tube appeared enlarged and was bleeding and appeared nonsalvageable. The right ovary appeared normal. The left ovary appeared to have an enlarged hemorrhagic cyst that was actively bleeding. The decision was made to proceed with right salpingectomy. An additional 5 mm trochar was inserted in the right upper quadrant for a surgeon's port under direct laparoscopic visualization using 4 cc Marcaine prior to making horizontal incisions along the skin lines. Trendelenberg position was obtained to facilitate pelvic exposure. The right fallopian tube was elevated away from the pelvic sidewall with an atraumatic grasper. The fallopian tube proximal to the implantation site was clamped, coagulated, and transected with the harmonic. The mesosalpinx was serially coagulated and cut. The tube and product of gestation were completely freed and retrieved using an Endo Catch bag. Endocatch device was introduced thru the 12 mm trochar and advanced near the specimen under direct vision of the laparoscope. The specimen was placed in the bad and retrieved. Attention was then turned to the left ovary. The left ovarian hemorrhagic cyst was found to be ruptured. Using the suction device the cyst was drained and contents and cell removed from the cyst. Remaining cyst was found to be friable. Monopolar cautery was used to achieve hemostasis. Arista was placed within the ovarian cyst and surrounding areas to obtain excellent hemostasis.
The abdomen and pelvis were thoroughly inspected. Good hemostasis noted at resection sites. The 5 mm trocars were withdrawn. The 12 mm trochar and laparoscope was then withdrawn and the pneumoperitoneum was released. The fascia was closed at the 12 mm port using the previously placed 0 Vicryl sutures. The uterine manipulator was removed from the vagina. Correct instrument count was confirmed. The skin incisions were closed with 4-0 Monocryl using running stitches and were covered with Dermabond. The patient was taken to the recovery room in stable condition.
