Bobby A
Guru
Date of procedure: 07/18/24
Pre-op diagnosis: other (dysmenorrhea)
Post-op diagnosis: same
Gynecological Procedure: hysterectomy, total laparoscopic, ovarian cystectomy, right, salpingectomy (right), other (vaginal mesh exci)
Anesthesia: GETA
Technique/ Findings:
The patient was taken to the operating room where general anesthesia was induced. She was placed in the dorsal lithotomy position with her legs in yellowfin stirrups and prepped and draped in the normal sterile fashion. An open sided Graves speculum was placed and the cervix was identified and grasped anteriorly with a single-tooth tenaculum. Additional Betadine was used to clean the cervix and the top of the vagina. The medium V care uterine manipulator was placed. A Foley catheter was placed using sterile technique. A vaginal balloon occluder was placed.
2 mL of half percent Marcaine with epinephrine 1:100,000 were injected infraumbilically. A vertical 1 cm infraumbilical incision was made with the 11 blade scalpel. The Veress needle was inserted and the abdomen was insufflated on low then high flow. The 10/12 XL trocar was placed under direct visualization. The patient was placed in steep Trendelenburg and two 5 mm left lower quadrant ports and one 5 mm right lower quadrant port were then placed under direct visualization similarly.
Complete anatomical survey revealed [a normal-appearing uterus tubes and ovaries]. The ureters were identified bilaterally. The left infundibulopelvic ligament was identified, coagulated, and transected. I proceeded down the through the round ligament. I then proceeded down to the left uterine artery which was skeletonized, coagulated and transected. The bladder flap was created to the midline. This was repeated on the right. The V care spatula was used on Valleylab mode to circumscribe the cervix using the green cup of the V care as a guide. The specimen was removed vaginally. The balloon occluder was replaced. The vaginal cuff was closed with the O V-loc suture in a continuous fashion also creating a uterosacral plication. The needle was removed under direct visualization. Irrigation was performed and excellent hemostasis was noted.
Attention was then directed vaginally where the vaginal balloon occluder was removed. The catheter was removed and cystoscopy was performed using a 70° cystoscope. The bladder was noted to be intact. Each ureteral orifice was noted to be ejecting clear urine appropriately. Attention was then directed to the abdomen where the umbilical fascia was closed with an 0 Vicryl figure of N suture. The skin incisions were all closed with 4-0 Monocryl simple interrupted buried sutures.
The TVT mesh was easily being extruded vaginally. The 2 tunnels laterally were epithelialized. I was able to get my instrument to the pubic bone and cut the mesh they are on each side and removed it. This was sent to pathology. I then undermined the tissue and really stick creating a plane so that newly incised vaginal epithelium could be reapproximated. The Foley catheter was left in place throughout this process and the urethra was intact. The vaginal mucosa was closed with a 3-0 Vicryl in a running continuous fashion. It should be noted that the TVT was coming out within 5 mm of the urethral meatus.
Estimated blood loss (mls): 50
Complications: none
Fluids: crystalloid
Specimens: fallopian tube, right, ovarian cyst wall (right ovary), uterus, other (TVT mesh)
Implants: None
Condition
Pre-op diagnosis: other (dysmenorrhea)
Post-op diagnosis: same
Gynecological Procedure: hysterectomy, total laparoscopic, ovarian cystectomy, right, salpingectomy (right), other (vaginal mesh exci)
Anesthesia: GETA
Technique/ Findings:
The patient was taken to the operating room where general anesthesia was induced. She was placed in the dorsal lithotomy position with her legs in yellowfin stirrups and prepped and draped in the normal sterile fashion. An open sided Graves speculum was placed and the cervix was identified and grasped anteriorly with a single-tooth tenaculum. Additional Betadine was used to clean the cervix and the top of the vagina. The medium V care uterine manipulator was placed. A Foley catheter was placed using sterile technique. A vaginal balloon occluder was placed.
2 mL of half percent Marcaine with epinephrine 1:100,000 were injected infraumbilically. A vertical 1 cm infraumbilical incision was made with the 11 blade scalpel. The Veress needle was inserted and the abdomen was insufflated on low then high flow. The 10/12 XL trocar was placed under direct visualization. The patient was placed in steep Trendelenburg and two 5 mm left lower quadrant ports and one 5 mm right lower quadrant port were then placed under direct visualization similarly.
Complete anatomical survey revealed [a normal-appearing uterus tubes and ovaries]. The ureters were identified bilaterally. The left infundibulopelvic ligament was identified, coagulated, and transected. I proceeded down the through the round ligament. I then proceeded down to the left uterine artery which was skeletonized, coagulated and transected. The bladder flap was created to the midline. This was repeated on the right. The V care spatula was used on Valleylab mode to circumscribe the cervix using the green cup of the V care as a guide. The specimen was removed vaginally. The balloon occluder was replaced. The vaginal cuff was closed with the O V-loc suture in a continuous fashion also creating a uterosacral plication. The needle was removed under direct visualization. Irrigation was performed and excellent hemostasis was noted.
Attention was then directed vaginally where the vaginal balloon occluder was removed. The catheter was removed and cystoscopy was performed using a 70° cystoscope. The bladder was noted to be intact. Each ureteral orifice was noted to be ejecting clear urine appropriately. Attention was then directed to the abdomen where the umbilical fascia was closed with an 0 Vicryl figure of N suture. The skin incisions were all closed with 4-0 Monocryl simple interrupted buried sutures.
The TVT mesh was easily being extruded vaginally. The 2 tunnels laterally were epithelialized. I was able to get my instrument to the pubic bone and cut the mesh they are on each side and removed it. This was sent to pathology. I then undermined the tissue and really stick creating a plane so that newly incised vaginal epithelium could be reapproximated. The Foley catheter was left in place throughout this process and the urethra was intact. The vaginal mucosa was closed with a 3-0 Vicryl in a running continuous fashion. It should be noted that the TVT was coming out within 5 mm of the urethral meatus.
Estimated blood loss (mls): 50
Complications: none
Fluids: crystalloid
Specimens: fallopian tube, right, ovarian cyst wall (right ovary), uterus, other (TVT mesh)
Implants: None
Condition