Dilation and curettage, hysteroscopy, and diagnostic laparoscopy

PREOPERATIVE DIAGNOSES:              Dysfunctional uterine bleeding and fibroid uterus.

POSTOPERATIVE DIAGNOSES:           Dysfunctional uterine bleeding and fibroid uterus.

OPERATION PERFORMED:                    Dilation and curettage, hysteroscopy, and diagnostic laparoscopy.

ANESTHESIA:                                             General.

EBL:                                                               None.

SPECIMEN SENT:                                      Endometrial curettings.

COMPLICATIONS:                                     None.

OPERATIVE FINDINGS:                           Hysteroscopic findings revealed a bilaterally normal tubal ostia, which were visualized without difficulty with what appeared to be a lush endometrial lining and some evidence of potential synechiae in the uterus, but the uterus was otherwise completely uniform in its cavity, and no evidence of polyps or impinging fibroids in the uterus itself.  Laparoscopically, the uterus appeared to be normal size with potential of a slight irregularity on the anterior surface consistent with possible intramural fibroids, but otherwise normal appearing fallopian tubes and ovaries bilaterally with no other pelvic pathology appreciated.

PROCEDURE IN DETAIL:                        The patient was taken to the operating room where she was identified as herself, placed in the dorsal lithotomy position and prepped and draped in the usual sterile fashion after general anesthesia was administered without difficulty.  A weighted speculum was placed in the vagina and the Deaver was placed anteriorly.  The anterior lip of the cervix was grasped with a single-tooth tenaculum, and the cervix was dilated to accommodate a 30-degree hysteroscope.  The 30-degree hysteroscope was introduced into the uterine cavity with the findings noted above, specifically normal tubal ostia visualized bilaterally, some evidence of possible synechiae in the uterus, but no other pelvic pathology appreciated with a lush endometrial lining and no polyps or fibroids in the uterine cavity.  The hysteroscope was removed, and the uterus was curetted until sufficiently gritty texture was noted throughout.  Once this was done, all instruments were removed from the patient’s vagina, and attention was turned to the patient’s abdomen.  A 5-mm incision was made above the umbilical fold, and the Veress needle was introduced with intraabdominal placement confirmed by appropriate pressure readings.  The abdomen was insufflated with CO2 gas.  The Veress needle was removed, and attention was turned to introducing a 5-mm trocar.  The 5-mm laparoscope introduced with the above finding.  Once the pelvis was visualized to our satisfaction with again no specific pathology noted inside the pelvis, all instruments were removed from the patient’s abdomen and vagina.  Sponge, needle, and instrument counts were correct x2.  The patient was taken to recovery room in stable and awake condition.  The findings were discussed in depth with the patient’s partner in the waiting room with the patient to be discharged home on the same day of surgery with followup in our office in approximately a week.