ealvarez113@hotmail.com
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CAN SOMEONE HELP ME WITH THIS....
PREOPERATIVE DIAGNOSES: Menorrhagia and right ovarian cyst.
POSTOPERATIVE DIAGNOSES Menorrhagia and thick endometrial lining, right
paratubal cyst and omental adhesions to the adnexa.
PROCEDURES: Hysteroscopy and D\T\C, hydrothermal ablation, right paratubal
cystectomy and resection of the omentum from the right adnexa.
ANESTHESIA: General.
ESTIMATED BLOOD LOSS: 50 mL
COMPLICATIONS: None.
CONDITION OF PATIENT: Stable.
INSTRUMENT COUNT AND LAP COUNT: Correct x 2.
SPECIMEN TO PATHOLOGY: Endometrial lining and the uterine polypoid
extensions, plus paratubal cyst.
FINDINGS: Patient had the normal endocervix. Thick endometrial lining with
uterus measuring about 8-9 cm. Patient also has a small submucosal fibroid
and some polypoid extension. On the laparoscopy, the patient had a right
paratubal cyst that was attached to the ovary giving the impression of right
ovarian cyst. Patient also had omentum adherent to the right ovary, which
prevented visualization of the ovary and fallopian tube and needed to be
dissected. Left adnexa appeared to be completely normal and the rest of the
abdominopelvic area appears to be normal.
DESCRIPTION OF PROCEDURE: Patient was placed in dorsolithotomy position. She
was prepped and draped in standard sterile fashion. Heavy-weighted speculum
was placed in the vagina. Foley catheter was placed into the bladder and the
cervix was elevated with a tenaculum. It was dilated to accommodate rigid
hysteroscope. Hysteroscopy was done, which showed thick endometrial lining
and polypoid extension, there was appearing of small deeply embedded
submucosal fibroid. Sharp curette was introduced and curetting was done.
After that hydrothermal ablation catheter was introduced. Uterus was filled
with normal saline and complete seal of the cervix was achieved with placing 2
tenaculums. Fluid was elevated to the temperature of 90 degrees Celsius and
hydrothermal ablation was carried on for 10 minutes. Fluid was cooled down to
the normal temperature and catheter was withdrawn. HUMI catheter was then
placed and the patient was repositioned. A new set of the instruments and
laps were used for the abdominal part of the procedure. The incision was done
in the abdomen and 5-mm trocar was placed. Additional 2 trocars were placed,
one in suprapubic area and the other one in right abdominal area and were used
for the various laparoscopic instruments including a PlasmaKinetic knife.
First, the omentum was noted to be adherent to the adnexa, preventing
visualization of the right side. The omentum was very carefully elevated with
atraumatic grasper and using laparoscopic scissors for the adhesions were
dissected and the omentum was dissected from the adnexa. Upon expecting to
the adnexa, the right paratubal cyst was noted measuring about 2 x 3 cm. It
was drained and dissected and the portion of the tube was sent to the
pathology. No further bleeding was seen. Everything else appeared to be
without any pathology. Instruments were removed. Abdomen was desufflated.
Incisions were closed with 3-0 Monocryl and reinforced with the Dermabond.
Patient was transferred to the recovery room in a stable condition.
I NEED HELP WITH THE RIGHT PARATUBAL CYSTECTOMY AND RESECTION.
PREOPERATIVE DIAGNOSES: Menorrhagia and right ovarian cyst.
POSTOPERATIVE DIAGNOSES Menorrhagia and thick endometrial lining, right
paratubal cyst and omental adhesions to the adnexa.
PROCEDURES: Hysteroscopy and D\T\C, hydrothermal ablation, right paratubal
cystectomy and resection of the omentum from the right adnexa.
ANESTHESIA: General.
ESTIMATED BLOOD LOSS: 50 mL
COMPLICATIONS: None.
CONDITION OF PATIENT: Stable.
INSTRUMENT COUNT AND LAP COUNT: Correct x 2.
SPECIMEN TO PATHOLOGY: Endometrial lining and the uterine polypoid
extensions, plus paratubal cyst.
FINDINGS: Patient had the normal endocervix. Thick endometrial lining with
uterus measuring about 8-9 cm. Patient also has a small submucosal fibroid
and some polypoid extension. On the laparoscopy, the patient had a right
paratubal cyst that was attached to the ovary giving the impression of right
ovarian cyst. Patient also had omentum adherent to the right ovary, which
prevented visualization of the ovary and fallopian tube and needed to be
dissected. Left adnexa appeared to be completely normal and the rest of the
abdominopelvic area appears to be normal.
DESCRIPTION OF PROCEDURE: Patient was placed in dorsolithotomy position. She
was prepped and draped in standard sterile fashion. Heavy-weighted speculum
was placed in the vagina. Foley catheter was placed into the bladder and the
cervix was elevated with a tenaculum. It was dilated to accommodate rigid
hysteroscope. Hysteroscopy was done, which showed thick endometrial lining
and polypoid extension, there was appearing of small deeply embedded
submucosal fibroid. Sharp curette was introduced and curetting was done.
After that hydrothermal ablation catheter was introduced. Uterus was filled
with normal saline and complete seal of the cervix was achieved with placing 2
tenaculums. Fluid was elevated to the temperature of 90 degrees Celsius and
hydrothermal ablation was carried on for 10 minutes. Fluid was cooled down to
the normal temperature and catheter was withdrawn. HUMI catheter was then
placed and the patient was repositioned. A new set of the instruments and
laps were used for the abdominal part of the procedure. The incision was done
in the abdomen and 5-mm trocar was placed. Additional 2 trocars were placed,
one in suprapubic area and the other one in right abdominal area and were used
for the various laparoscopic instruments including a PlasmaKinetic knife.
First, the omentum was noted to be adherent to the adnexa, preventing
visualization of the right side. The omentum was very carefully elevated with
atraumatic grasper and using laparoscopic scissors for the adhesions were
dissected and the omentum was dissected from the adnexa. Upon expecting to
the adnexa, the right paratubal cyst was noted measuring about 2 x 3 cm. It
was drained and dissected and the portion of the tube was sent to the
pathology. No further bleeding was seen. Everything else appeared to be
without any pathology. Instruments were removed. Abdomen was desufflated.
Incisions were closed with 3-0 Monocryl and reinforced with the Dermabond.
Patient was transferred to the recovery room in a stable condition.
I NEED HELP WITH THE RIGHT PARATUBAL CYSTECTOMY AND RESECTION.