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Total Abdominal Hysterectomy RSO MT Sample Report


SURGEON:  John Doe, MD


DESCRIPTION OF OPERATION: The patient was taken to the operating room with IV running and transferred to the operating table, where she was placed in the dorsal supine position. General anesthesia was given. She was prepped and draped in the normal sterile fashion. The initial skin incision was made with a scalpel and carried down to the underlying layer of fascia. The fascia was incised in the midline. There were dense adhesions in the subcutaneous tissue. The fascia was then extended with the curved Mayo scissors. The superior aspect of the incision was grasped with Kocher clamps, elevated and the underlying rectus muscle was dissected off both bluntly and sharply.

Attention was turned to the inferior aspect of the incision, which in a similar fashion was grasped with Kocher clamps, elevated and underlying rectus muscle was dissected off both bluntly and sharply. The peritoneum was identified and entered bluntly and peritoneal incision extended inferiorly and superiorly with good visualization of the bladder. On examination of the pelvis, there was noted to be filmy adhesions surrounding the uterus, as well as dense bowel adhesions to the peritoneal wall. Prior to placing a retractor, the bowel was taken off the left lateral peritoneal wall.

Once this was safely taken down, the Bookwalter retractor was placed without difficulty. The bowel was packed away with moist laparotomy sponges, and on examination of the pelvis, the uterus could be visualized and was adhesed to the anterior peritoneal wall. These adhesions in the bladder were taken down sharply with Metzenbaum scissors. The uterus was clamped bilaterally with Kocher clamps for manipulation at the cornua. The round ligament was then transected, suture ligated on the left side. This was done in a similar fashion on the right side. Both ovaries were noted to be fairly well adhered to the peritoneal wall; therefore, decision was made to proceed with total abdominal hysterectomy and evaluate the ovaries for potential removal.

A window was made in the broad ligament and the tubo-ovarian ligaments were doubly clamped and suture ligated with 0 Vicryl suture bilaterally. Hemostasis was visualized. The uterine arteries were skeletonized bilaterally, clamped with Zeppelin clamps and suture ligated. Again, hemostasis was assured. The uterosacral ligaments were clamped on both sides, transected and suture ligated in similar fashion. The cervix and uterus were then amputated with the Jorgensen scissors. Vaginal cuff angles were closed with figure-of-eight 0 Vicryl suture and the remainder of the vaginal cuff was then closed with a series of interrupted 0 Vicryl sutures. Hemostasis was assured.

Attention was then turned to the ovaries. The right ovary was noted to have a cyst, which ruptured revealing clear cystic fluid on manipulation. The ureter was palpated and the IP ligament was then clamped and transected and the ovarian tissue on the right side was removed and sent to Pathology. The left ovary was then visualized and the left ureter palpated. However, the left ovary was noted to be very adherent to the peritoneal cavity and bowel, and due to the anticipated potential blood loss and complications to bowel, the decision was made to leave this ovary in place. The pelvis was then copiously irrigated. There was noted to be a small amount of bleeding at the site of the round ligament. Then, 2-0 Vicryl sutures was placed. Hemostasis was obtained. There was also noted to be a small amount of bleeding at the posterior cuff, which also was made hemostatic with 2-0 Vicryl suture.

All instruments were then removed. Seprafilm was placed to prevent further adhesions. All sponges, laps and needles were removed. The fascia was then reapproximated with 0 Vicryl suture, beginning at both sides and meeting at the midline. Subcutaneous tissue was reapproximated with 3-0 Vicryl suture and staples were placed as well as a sterile dressing. The patient tolerated the procedure well and was transferred to the recovery room in stable condition without complications.