Bobby A
Guru
need help coding this one out please and thank you
Pre-op diagnosis: prolapse (cystocele)
Post-op diagnosis: same (plus vaginal vault prolapse)
Gynecological Procedure: colporrhaphy, anterior, sacrospinous ligament fixation
1. Stage 3 cystocele with stage 2 vaginal vault prolapse; no rectocele
The patient was taken the operating room where general anesthesia was induced. She was placed in the dorsal lithotomy position using yellowfin stirrups and prepped and draped in the usual sterile fashion. A Foley catheter was placed. A timeout was performed. Attention was directed anteriorly where the vaginal cuff was grasped with 2 long Allis clamps. Half percent lidocaine with epinephrine 1:100,000 was injected between the 2 Allis clamps and in the midline to within 1 cm of the urethral meatus. A 15 blade scalpel was used to incise between the 2 Allis clamps. Tenotomy scissors were then used to undermine and incise the vaginal mucosa in the midline. The edges of the vaginal mucosa were held with Allis clamps. Sharp and blunt dissection were used to dissect the mucosa off the underlying tissue. The endopelvic fascia was then plicated in the midline using simple interrupted stitches of 0 Vicryl suture. Excellent support of the bladder was noted. Attention was then turned to the vaginal vault suspension. The right paravesical and paravaginal tissue was dissected bluntly to the level of the ischial spine. The sacrospinous ligament was then palpated. Using the Capio device, a single 0 Ethibond stitch was placed through the sacrospinous ligament approximately 1 cm proximal to the ischial spine. The bullets were then cut off and the stitch was loaded onto a Mayo needle and passed through the remnant of the right uterosacral ligament. This stitch was then held. The excess vaginal epithelium was trimmed and the incision was closed half-way with a 2-0 Vicryl suture in a running fashion. The sacrospinous stitch was then tied down and excellent support of the vaginal vault was noted. The remaining portion of the incision was then closed. The patient tolerated the procedure well. All counts were correct. She was taken to the recovery area in stable condition.
Pre-op diagnosis: prolapse (cystocele)
Post-op diagnosis: same (plus vaginal vault prolapse)
Gynecological Procedure: colporrhaphy, anterior, sacrospinous ligament fixation
1. Stage 3 cystocele with stage 2 vaginal vault prolapse; no rectocele
The patient was taken the operating room where general anesthesia was induced. She was placed in the dorsal lithotomy position using yellowfin stirrups and prepped and draped in the usual sterile fashion. A Foley catheter was placed. A timeout was performed. Attention was directed anteriorly where the vaginal cuff was grasped with 2 long Allis clamps. Half percent lidocaine with epinephrine 1:100,000 was injected between the 2 Allis clamps and in the midline to within 1 cm of the urethral meatus. A 15 blade scalpel was used to incise between the 2 Allis clamps. Tenotomy scissors were then used to undermine and incise the vaginal mucosa in the midline. The edges of the vaginal mucosa were held with Allis clamps. Sharp and blunt dissection were used to dissect the mucosa off the underlying tissue. The endopelvic fascia was then plicated in the midline using simple interrupted stitches of 0 Vicryl suture. Excellent support of the bladder was noted. Attention was then turned to the vaginal vault suspension. The right paravesical and paravaginal tissue was dissected bluntly to the level of the ischial spine. The sacrospinous ligament was then palpated. Using the Capio device, a single 0 Ethibond stitch was placed through the sacrospinous ligament approximately 1 cm proximal to the ischial spine. The bullets were then cut off and the stitch was loaded onto a Mayo needle and passed through the remnant of the right uterosacral ligament. This stitch was then held. The excess vaginal epithelium was trimmed and the incision was closed half-way with a 2-0 Vicryl suture in a running fashion. The sacrospinous stitch was then tied down and excellent support of the vaginal vault was noted. The remaining portion of the incision was then closed. The patient tolerated the procedure well. All counts were correct. She was taken to the recovery area in stable condition.