DESCRIPTION OF OPERATION: The patient was taken to the operating room and spinal anesthetic was administered. The patient was prepped and draped in the usual sterile fashion for cesarean section. After confirmation of adequate level of anesthesia, a Pfannenstiel incision was made on the patient's skin. Using sharp dissection, the incision was carried down to the peritoneum, which was opened superiorly and extended in a transverse manner. A bladder blade was placed. The vesicouterine peritoneum was dissected in order to create a bladder flap, which was also retracted with the bladder blade. A transverse incision was made in the lower uterine segment and the incision was carried laterally and superiorly bluntly. A live-born, 10 pound 5 ounce male infant was delivered from the cephalic presentation with clear amniotic fluid. Apgars of 9 and 9. The infant's cord was doubly clamped and cut, and the infant was handed to the neonatology staff in attendance. Cord blood was obtained. The placenta was delivered manually. The uterus was wiped clean of any retained membranes. The uterus was delivered onto the anterior abdominal surface for repair. Right tube and ovary were within normal limits. There was a 4 cm ovarian cyst that was known to us from the prenatal course, consistent with dermoid. The uterine incision was repaired in a single layer with #1 chromic suture. It was a running interlocking stitch started from each angle. A couple of additional interrupted stitches were required for complete hemostasis. Once hemostasis was obtained, the area was irrigated thoroughly and hemostasis was confirmed. At this time, our attention was turned towards the left-sided ovarian cyst. The ovary was surrounded by two moist laps. Using a scalpel with a 10 blade, an incision was made directly above the cyst away from the infundibulopelvic ligament. Immediately upon making the incision, the cyst was ruptured, yielding sebaceous fluid, solid elements and hair consistent with a dermoid cyst. All of the elements were removed. The cyst wall was excised. The ovarian capsule was reapproximated using 3-0 Vicryl suture. The area was irrigated thoroughly and then the ovary was wrapped with Interceed. At this time, the uterine incision was checked for hemostasis. After hemostasis was confirmed, the area was irrigated thoroughly. The uterus was placed back into the abdominal cavity. The pelvis was then irrigated using copious amounts of sterile saline. The abdominal wall was then closed as follows. The fascia was reapproximated from each angle using 0 Vicryl. The subcutaneous was irrigated and the skin was closed with staples. Estimated blood loss was 750 mL. There were no apparent intraoperative complications. The Foley catheter drained clear urine at the end of the procedure. Counts were correct. Specimens consisted of the left-sided dermoid cyst. The patient tolerated the procedure well and was taken to the recovery area in satisfactory condition.
