1.
Ovarian cyst.
2.
Pelvic mass.
3.
Pelvic pain.
4.
Adnexal torsion.
5.
Pelvic hematoma.
POSTOPERATIVE
DIAGNOSES:
1.
Ovarian cyst.
2.
Pelvic mass.
3.
Pelvic pain.
4.
Adnexal torsion.
5.
Pelvic hematoma.
6.
Right paratubal cyst, torsion.
7.
Omental hematoma.
OPERATIONS
PERFORMED:
1.
Laparoscopic right ovarian, paratubal cystectomy.
2.
Omentectomy, resection of abdominal hematoma.
ANESTHESIA:
General.
COMPLICATIONS: None.
ESTIMATED BLOOD LOSS: Less than 300 mL.
DISPOSITION: The patient was transferred to the recovery
room in stable condition.
JUSTIFICATION: The patient presents on 04/10/09 for the above procedures and
for the above diagnoses. The patient
understands the indications, rationale, presumptive complications and
risks. She is aware that these risks
include infection, bleeding, injury to adjacent structures such as the bowel or
bladder as well as potential cardiac or pulmonary complications, and risk of
anesthesia. The patient is aware of the
potential for thromboembolic events including deep vein thrombosis, stroke, and
pulmonary embolus. The patient is aware
of the potential for alteration in pelvic anatomy including potential future
limitations in pregnancy carriage, and fertility. All of the patient's questions have been
answered, apparently to her satisfaction.
The patient has elected to proceed with surgery, and is medically
cleared.
PROCEDURE
IN DETAIL: Following documentation of informed consent
for the above procedures, the patient was brought to the operative suite where
she was administered general anesthesia, prepped and draped in the usual
sterile fashion in the low lithotomy position and Allen stirrups. An infraumbilical incision was made with the
11 blade knife to accommodate the Veress needle, which was placed. Its location was established by saline drop
test, infusion and aspiration test. The
abdomen was insufflated with several liters of CO2 gas. The Veress needle was removed. The umbilical incision was dilated to
accommodate the 11 mm port, which was placed.
The laparoscope was introduced into the abdominal cavity. Initial examination of the abdomen and pelvis
was conducted. Findings were notable for
a right paratubal, ovarian cyst, with torsion noted, about the omentum with
hematoma within the omentum spanning 4-5 cm.
Accessory trocars were placed midway between the anterior superior iliac
crest and the umbilicus on the left side using a 5 mm port, with a 12 mm port placed
two fingerbreadths above the symphysis pubis in the midline. All ports were placed under direct
visualization to avoid injury to underlying structures. Abdominal wall transillumination was utilized
to avoid regional blood supply. Pelvic
washings were obtained. A thorough and
systematic exploration of the abdomen and pelvis was conducted. The above findings were again noted and
confirmed. The omentum was localized
into the pelvis. Omentectomy was carried
out, resecting the omentum proximal to the area of hematoma, and adherent to
the paratubal and paraovarian cyst.
Exact hemostasis was noted along the resection margin which was
cauterized with bipolar cautery and Endoshears.
The mass and adnexa were mobilized in the lateral to medial
direction. The mass was resected from
the region of the right pelvic sidewall, isolated and resected from mesovarium,
and fallopian tube mesentery. The mass
was delivered to the abdomen, contained within an Endopouch, via the 12 mm port
site. The abdomen and pelvis were
irrigated. Good hemostasis was noted at
all pedicles. All instruments were
removed from the abdomen and pelvis. All
accessory trocars were removed followed by the laparoscope and the umbilical
trocar. Air was allowed to escape from
the abdominal cavity. 0 Vicryl suture
was used to reapproximate the fascial margins followed by 4-0 Monocryl used to
reapproximate skin margins. Dressings
were applied. All sponge and needle
counts were correct x3 at the end of the case.
The patient tolerated these procedures well, and was transferred to the
recovery room in stable condition.
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Hospitals in Chennai
your are welcome sir, it is pleasure.
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