Exploratory laparotomy and total abdominal hysterectomy

PREOPERATIVE DIAGNOSIS:  Symptomatic fibroids.

POSTOPERATIVE DIAGNOSIS:  Symptomatic fibroids.

OPERATION PERFORMED:  Exploratory laparotomy and total abdominal hysterectomy.

ANESTHESIA:  General endotracheal anesthesia.

ESTIMATED BLOOD LOSS:  250 mL.

URINE OUTPUT:  400 mL.

IV FLUIDS:  2600 mL.

FINDINGS:  Approximately 16-week size uterus, normal bilateral tubes and ovaries.

SPECIMENS:  Uterus and cervix.

PROCEDURE IN DETAIL:  The patient was taken to the operating room where general anesthesia was found to be adequate.  She was then prepped and draped in normal sterile fashion in the supine position.  A transverse skin incision was then made with the scalpel and carried through the underlying layer of fascia.  Fascia was incised in the midline.  The incision was extended laterally.  The muscles were separated in the midline and peritoneum was entered bluntly.  The uterus was then delivered through the incision and the patient’s left round ligament was clamped, transected and tied.  Hemostasis was noted in a similar fashion.  The patient’s right round ligament was clamped, transected, and tied.  Both were tagged.  The left utero-ovarian ligament was then in a similar fashion clamped, transected, and suture ligated bilaterally.  Bilateral ureter ends were skeletonized and bladder flap was created.  With sharp dissection, the bladder was dissected off of the cervix.  A curved Heaney clamp was then used to clamp the uterine bilaterally, which were clamped, transected, and ligated.  Bilateral parametria were taken down to the level of the cervicovaginal junction.  The cervix and uterus were then transected from the vagina and the vagina was closed with interrupted figure-of-eight using #1 Vicryl.  Hemostasis was again noted.  Irrigation was performed and all pedicles were visualized and noted to be hemostatic.  Bilateral ureters were visualized and noted to be peristalsing.  The fascia was then reapproximated using #1 Vicryl in a running fashion.  Skin was closed with 4-0 Monocryl in a subcuticular fashion.  The patient tolerated the procedure well.  Sponge, lap, and needle count were correct x2.  The patient was taken to recovery room in stable condition.