Laparoscopy with fulguration and excision of probable endometriosis.

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Holmes Colleges Melbourne *

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801

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Nursing

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Nov 24, 2024

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PREOPERATIVE DIAGNOSES : 1. Dysmenorrhea. 2. Infertility. POSTOPERATIVE DIAGNOSES : 1. Dysmenorrhea. 2. Infertility. 3. Probable endometriosis and evidence of pelvic adhesions from colitis. OPERATIVE PROCEDURE : 1. Laparoscopy with fulguration and excision of probable endometriosis. 2. Cystoscopy with hydrodistention of the bladder. 3. Chromotubation of the tubes. SURGEON : Carol Borden, MD ASSISTANT : Utley ANESTHESIA : General anesthesia by Dr. Zhou ESTIMATED BLOOD LOSS : Less than 100 mL DRAINS : None COMPLICATIONS : None FINDINGS : Normal-appearing liver edge and appendix. Uterus was retroverted. Tubes appeared normal. They both filled and spilled with methylene blue dye. Ovaries appeared normal. Evidence of colitis from the rectosigmoid being scarred to the inferior portion of the left ovary as well as the pelvic brim and up to the anterior abdomen. No evidence of interstitial cystitis. DESCRIPTION OF PROCEDURE : The patient was taken to the operating room. She underwent general anesthesia. Her legs were placed in lithotomy position. Her abdomen, perineum, and vagina were sterilely prepped and draped. A weighted speculum was placed in the vagina. The anterior lip of the cervix was grasped using a single-tooth tenaculum. The HUMI manipulator was placed in the endocervical canal. The single-tooth tenaculum and weighted speculum were removed. The operator’s gloves were changed.

Attention was turned to the abdomen where 0.25% Marcaine was injected in the umbilicus. A vertical incision was made through the umbilicus. A Veress needle was placed through the incision. Intra-abdominal placement was noted with the opening pressure being less 10. The abdomen was then insufflated with 3 liters of CO2. The Veress needle was removed and a 5-mm Optiview trocar with laparoscope and sheath were placed through the incision under direct visualization. This revealed an atraumatic intra-abdominal placement. The trocar was removed and laparoscope was placed through the sheath. A 0.25% Marcaine was injected in the left lower quadrant. A scalpel was used to make an incision. A 5-mm trocar with sheath was placed through the incision under direct visualization. This revealed an atraumatic intra-abdominal placement. The trocar was removed and a grasper was placed through the sheath. The patient was placed in Trendelenburg. Inspection of the pelvis and upper abdomen revealed findings noted above. Chromotubation was performed which revealed blue dye spilling freely from both tubes. Evidence of possible early endometriosis in the anterior cul-de-sac was identified and was excised using the biopsy forceps and then cauterized using Kleppinger cautery. There was old white scarring in the cul-de-sac and in the left ovarian fossa which were _______ implants cauterized using Kleppinger cautery. The pelvis was copiously irrigated. All surgery was performed well away from the bowel, bladder, and ureter. The adhesion of the bowel to the inferior aspect of the left ovary continued up along with pelvic brim and into the upper abdomen consistent with old bout of colitis associated with endometriosis. There was no other evidence of any endometriosis on the ovary and the entire underside of the ovary was able to be seen. The scarring was adherent to the edge of the ovary. All instruments were removed. The abdomen was completely desufflated. The ports were then removed. The incisions were closed using 4-0 Vicryl in a subcuticular fashion. Steri-Strips and Band-Aids were then applied. Attention was turned to the perineum. The HUMI manipulator was removed from the cervix. Cystoscope was performed with hydrodistention. The bladder was instilled with 250 mL of sterile water. It was left in situ for about 7 minutes. The bladder was then drained and there was no evidence of petechial hemorrhages. The bladder was then instilled again with 250 mL of sterile water which was its maximum capacity. It was left in situ for about 5 minutes. It was again drained and there was no evidence of any petechial hemorrhages. All instruments were removed. The patient was taken out of the lithotomy position. She was awakened from general anesthesia and taken to the recovery room in good condition with the physician in attendance.

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