Dilation and Curettage with Hysteroscopy Operative Sample

DETAILS OF PROCEDURE:  After excellent general anesthesia, the patient was prepped and draped in sterile fashion in the dorsal lithotomy position. The one laminaria that had been placed in the cervix on the day prior to surgery was removed and intact. The cervix was noted to be dilated. A weighted vaginal speculum was placed in the vaginal vault. Anterior lip of the cervix was grasped with the single tooth tenaculum. Endocervical curettings were then done. The hysteroscope was then placed under direct visualization. Warm lactated Ringer's was used as a distention medium. Two endometrial polyps were noted in the anterior portion and one in the left fundal region. Pictures were taken. Hysteroscope was removed and the polyps were removed with polyp forceps as well as sharp curettage was performed. All of this material was sent as endometrial curettings. A hysteroscope was then reinserted again under direct visualization and the polyps were noted to be gone. Bleeding endometrium was noted. No other abnormalities were noted. It was difficult to visualize the ostia on both sides. The hysteroscope was removed. Sharp curettage was performed once more and then all instruments were removed. Sponge and needle counts were correct x2. Estimated blood loss was 25 mL. The patient received 500 mL of crystalloid fluids. The distention medium used was warm lactated Ringer's, 1000 mL went in and 800 mL came out for a net differential of 200 mL. The patient awoke easily in the operating room and was taken to the recovery in stable condition.