Laparoscopic left salpingo-oophorectomy and lysis of adhesions

PREOPERATIVE DIAGNOSIS:                Ovarian cyst.

POSTOPERATIVE DIAGNOSES:           Ovarian cyst, left hemorrhagic ovarian cyst with pelvic adhesions.

PROCEDURE PERFORMED:                  Laparoscopic left salpingo-oophorectomy and lysis of adhesions.

ANESTHESIA:                                             General.

EBL:                                                               None.

SPECIMEN SENT:                                                 Left fallopian tube and ovary.

URINE OUTPUT:                                        Clear yellow urine throughout course of procedure.

FINDINGS:                                                    Operative findings revealed a completely normal right fallopian tube and ovary with a Falope-ring noted on the right fallopian tube consistent with the patient’s history of previous tubal ligation.  The left fallopian tube and ovary were encompassed by a large 6 cm hemorrhagic cyst and adhesed to the left pelvic side wall and the pelvic cul-de-sac.

PROCEDURE IN DETAIL:                        The patient was taken to the operating room where she was identified as herself, placed in the dorsal lithotomy position.  After general anesthesia was administered without difficulty, she was prepped and draped in the usual sterile fashion with a 5-mm incision made in the umbilical fold and Veress needle introduced into the intraabdominal cavity where intraabdominal placement was confirmed by appropriate pressure reading.  The abdomen was insufflated with CO2 gas and the Veress needle was removed.  A 5-mm, 0-degree laparoscope was introduced with the findings noted above.  At this time, 2 further incisions were made in the left lower quadrant and the right lower quadrant respectively to accommodate a 10-mm trocar and a 5-mm trocar respectively under direct visualization lateral to the inferior epigastric vessels.  The patient was placed in steep Trendelenburg positioning with the bowel displaced superiorly.  At this time, attention was turned to judicious adhesiolysis of and around the left fallopian tube and ovarian cyst with the adhesions of the omentum and the bowel judiciously teased free utilizing the harmonic scalpel, and the infundibular pelvic ligament was able to be isolated and transected utilizing the harmonic scalpel.  The ovarian cyst was then again judiciously dissected free of its adhesions to the pelvic side wall until it was completely freed from its moorings in the pelvic cul-de-sac and the side wall.  The left fallopian tube and ovary replaced into a Endopouch and removed without difficulty through the left lower quadrant port site in the Endopouch.  At this time, the abdomen was copiously irrigated, cleared of all clots and debris with again the right ovary appearing completely normal and the abdomen completely hemostatic.  All instruments were subsequently removed from the patient’s abdomen.  The CO2 gas was expelled.  The 10-mm fascial defect in the left lower quadrant was closed with a 0-Vicryl interrupted stitch, and the patient’s 3 skin incisions were closed in a subcuticular fashion with 4-0 Monocryl.  The patient was taken to recovery room in stable awake condition with discharge home same day.

FOLLOWUP:  Follow up to be in our office in approximately 5 days with the patient to call for appointment and a script for Percocet given for pain.