karey
Networker
My Doc did a laparoscopic assisted ovarian cystectomy. I suggest 58662 and he says 58925 since he did a mini-lap and dissected the cyst off of the ovary via scalpel. Any thoughts? here is the OP note
The direct open technique was used to enter
The direct open technique was used to enter
infraumbilically.
[FONT=COURIER,sans-serif]
[/FONT]
[FONT=COURIER,sans-serif]Once intra-abdominal placement was confirmed, the Hasson port was [/FONT][FONT=COURIER,sans-serif]placed.A pneumoperitoneum was created. An anatomical survey revealed [/FONT][FONT=COURIER,sans-serif]the above findings. Two 5 mm ports were placed on the left and right [/FONT][FONT=COURIER,sans-serif]mid quadrants under direct visualization.After an anatomical survey [/FONT][FONT=COURIER,sans-serif]was performed, we were able to place the port directly into the mass.[/FONT][FONT=COURIER,sans-serif]Pressure was held along the port site and the suction irrigator was[/FONT]
[FONT=COURIER,sans-serif]placed within the ovarian cyst.Approximately 5 L of clear fluid was [/FONT][FONT=COURIER,sans-serif]obtained. After this was done, further anatomic survey revealed no [/FONT][FONT=COURIER,sans-serif]abnormalities.[/FONT]
[FONT=COURIER,sans-serif]
[/FONT]
[FONT=COURIER,sans-serif]We then switched to a 5 mm camera. We grasped the mass through the [/FONT][FONT=COURIER,sans-serif]umbilical port, removed the camera and the pneumoperitoneum was reduced.[/FONT][FONT=COURIER,sans-serif]We then secured a suture to the mass and placed it back in the abdomen [/FONT][FONT=COURIER,sans-serif]so that we could place an Alexis retractor. We first extended the skin [/FONT][FONT=COURIER,sans-serif]in a minimal fashion. We then grabbed the suture and brought it up[/FONT]
[FONT=COURIER,sans-serif]through the abdominal incision.We identified the tube and fimbria as [/FONT][FONT=COURIER,sans-serif]well as the ovary. This appeared to be more of a paratubal cyst than an [/FONT][FONT=COURIER,sans-serif]ovarian cyst.[/FONT]
[FONT=COURIER,sans-serif]
[/FONT]
[FONT=COURIER,sans-serif]At the previous puncture site we started the cystectomy. We peeled away [/FONT][FONT=COURIER,sans-serif]the overlying potentially peritoneal tissue and removed the entire cyst [/FONT][FONT=COURIER,sans-serif]with sharp and blunt dissection. Excellent hemostasis was obtained with [/FONT][FONT=COURIER,sans-serif]Bovie cautery. This was completely removed.The tube was inspected and[/FONT]
[FONT=COURIER,sans-serif]noted to be intact.However there was a hernia created during the [/FONT][FONT=COURIER,sans-serif]cystectomy. We then placed the edges of appeared to be the peritoneum [/FONT][FONT=COURIER,sans-serif]and these were closed in a running 2-0 Dexon.[/FONT]
[FONT=COURIER,sans-serif]
[/FONT]
[FONT=COURIER,sans-serif]The tube was then placed next to the ovary and all of the raw surfaces [/FONT][FONT=COURIER,sans-serif]were closed and excellent hemostasis was noted.This was placed back in [/FONT][FONT=COURIER,sans-serif]the abdomen. The retractor was then removed.The fascia was closed [/FONT][FONT=COURIER,sans-serif]with 0 Maxon in a running fashion.The subcutaneous area was irrigated [/FONT][FONT=COURIER,sans-serif]and reapproximated using 2-0 Dexon. The skin was closed using 4-0 Dexon [/FONT][FONT=COURIER,sans-serif]and skin glue. We also removed the lateral 5 mm ports and closed the [/FONT][FONT=COURIER,sans-serif]skin in a similar fashion. The patient was taken to the recovery room [/FONT][FONT=COURIER,sans-serif]in stable condition without complications.[/FONT]
[FONT=COURIER,sans-serif]
[/FONT]
[FONT=COURIER,sans-serif]Once intra-abdominal placement was confirmed, the Hasson port was [/FONT][FONT=COURIER,sans-serif]placed.A pneumoperitoneum was created. An anatomical survey revealed [/FONT][FONT=COURIER,sans-serif]the above findings. Two 5 mm ports were placed on the left and right [/FONT][FONT=COURIER,sans-serif]mid quadrants under direct visualization.After an anatomical survey [/FONT][FONT=COURIER,sans-serif]was performed, we were able to place the port directly into the mass.[/FONT][FONT=COURIER,sans-serif]Pressure was held along the port site and the suction irrigator was[/FONT]
[FONT=COURIER,sans-serif]placed within the ovarian cyst.Approximately 5 L of clear fluid was [/FONT][FONT=COURIER,sans-serif]obtained. After this was done, further anatomic survey revealed no [/FONT][FONT=COURIER,sans-serif]abnormalities.[/FONT]
[FONT=COURIER,sans-serif]
[/FONT]
[FONT=COURIER,sans-serif]We then switched to a 5 mm camera. We grasped the mass through the [/FONT][FONT=COURIER,sans-serif]umbilical port, removed the camera and the pneumoperitoneum was reduced.[/FONT][FONT=COURIER,sans-serif]We then secured a suture to the mass and placed it back in the abdomen [/FONT][FONT=COURIER,sans-serif]so that we could place an Alexis retractor. We first extended the skin [/FONT][FONT=COURIER,sans-serif]in a minimal fashion. We then grabbed the suture and brought it up[/FONT]
[FONT=COURIER,sans-serif]through the abdominal incision.We identified the tube and fimbria as [/FONT][FONT=COURIER,sans-serif]well as the ovary. This appeared to be more of a paratubal cyst than an [/FONT][FONT=COURIER,sans-serif]ovarian cyst.[/FONT]
[FONT=COURIER,sans-serif]
[/FONT]
[FONT=COURIER,sans-serif]At the previous puncture site we started the cystectomy. We peeled away [/FONT][FONT=COURIER,sans-serif]the overlying potentially peritoneal tissue and removed the entire cyst [/FONT][FONT=COURIER,sans-serif]with sharp and blunt dissection. Excellent hemostasis was obtained with [/FONT][FONT=COURIER,sans-serif]Bovie cautery. This was completely removed.The tube was inspected and[/FONT]
[FONT=COURIER,sans-serif]noted to be intact.However there was a hernia created during the [/FONT][FONT=COURIER,sans-serif]cystectomy. We then placed the edges of appeared to be the peritoneum [/FONT][FONT=COURIER,sans-serif]and these were closed in a running 2-0 Dexon.[/FONT]
[FONT=COURIER,sans-serif]
[/FONT]
[FONT=COURIER,sans-serif]The tube was then placed next to the ovary and all of the raw surfaces [/FONT][FONT=COURIER,sans-serif]were closed and excellent hemostasis was noted.This was placed back in [/FONT][FONT=COURIER,sans-serif]the abdomen. The retractor was then removed.The fascia was closed [/FONT][FONT=COURIER,sans-serif]with 0 Maxon in a running fashion.The subcutaneous area was irrigated [/FONT][FONT=COURIER,sans-serif]and reapproximated using 2-0 Dexon. The skin was closed using 4-0 Dexon [/FONT][FONT=COURIER,sans-serif]and skin glue. We also removed the lateral 5 mm ports and closed the [/FONT][FONT=COURIER,sans-serif]skin in a similar fashion. The patient was taken to the recovery room [/FONT][FONT=COURIER,sans-serif]in stable condition without complications.[/FONT]