OPERATION IN DETAIL: In the operating room, under general anesthetic, the patient was prepped and draped in the supine position. The bladder was emptied with a catheter. A 5 mm incision was made within the umbilicus and the edges held with towel clips. A Veress needle was placed into the peritoneal cavity verifying entry with water instillation. Gas was insufflated until the filling pressure met the preset pressure. The needle was removed and replaced with a 5 mm trocar, through which a laparoscopic camera was inserted. No trauma was seen beneath the site of insertion. The upper abdomen was visualized and photographed. The patient was then placed in Trendelenburg. Under direct vision, after transillumination of the abdominal wall and identification of epigastric vessel, a 5 mm port was placed suprapubically and another in the left lower quadrant. The above findings were noted and photographed. Both ureters were identified and the iliac vessels also identified. Using the SonoSurg instrument, the adhesions were divided. No trauma occurred to the intestines, the bowel, ureter or the blood vessels. All visible adhesions were divided. Minimal bleeding was encountered. Photos were taken. A slurry using a procedure pack of Seprafilm and 50 mL of warm saline was created and instilled into the pelvis to reduce the risk of future adhesions. Gas was released and all instruments were removed. The incisions were closed with interrupted Prolene sutures. The patient was repositioned, awakened, and taken to the recovery room in good condition. All instrument and sponge counts were correct.
