PREOPERATIVE DIAGNOSIS: Chronic pelvic pain and endometriosis.
POSTOPERATIVE DIAGNOSIS: Chronic pelvic pain and endometriosis.
PROCEDURE PROPOSED: Diagnostic laparoscopy, bilateral salpingo-oophorectomy, and possible exploratory laparotomy.
PROCEDURE PERFORMED: Diagnostic laparoscopy, lysis of adhesions, fulguration of filmy adhesions, and a bilateral salpingo-oophorectomies.
INCISIONS: Subumbilical, suprapubic, and left lower abdominal.
The uterus was absent.
Filmy and dense adhesions from the left ovary and tube to the left pelvic sidewall.
Normal-appearing ovaries bilaterally.
Some filmy tissue at the right pelvic sidewall consistent with endometriosis and this was fulgurated.
Both ureters were visualized and noted to have normal peristaltic motion.
Filmy adhesions present from the cecum to the anterior abdominal wall.
Photographs were taken.
DESCRIPTION OF THE PROCEDURE: In the operating room general anesthesia was administered without complication. The patient was prepped and sterilely draped for diagnostic laparoscopy. A Foley catheter was placed. Sponge stick was placed in the vagina for possible elevation of the vaginal cuff.
A subumbilical incision was made with a scalpel and the abdomen was entered in an open laparoscopy fashion. The 10-mm Hasson trocar was inserted into the abdominal cavity bluntly and secured to the fascia with 0 Polysorb interrupted sutures. The abdomen was insufflated with CO2 gas to a pressure of 15 PSI. Suprapubic and left lower abdominal incisions were made and 5-mm trocars were inserted under direct visualization. The pelvis was examined, with findings as noted above. Photographs were taken.
The adhesions from the left ovary and tube to the pelvic sidewall were taken down with sharp and blunt dissection to free up the left ovary. The left ovary and distal tube were grasped with graspers and then retracted medially away from the pelvic sidewall. The ovarian vessels were cauterized with bipolar cautery and the ovary and distal tube were excised with scissors. The same process was used to excise the right ovary and distal tube. A probe was placed through the 5 mm trocar, which was then removed. A 7-mm trocar was then inserted over the probe through the suprapubic incision. Using large sharp graspers both ovaries were then removed from the abdomen through the 7-mm trocar. Adhesions from the cecum to the anterior abdominal wall were also taken down with sharp and blunt dissection. Hemostasis was obtained with bipolar cautery. The pelvis was irrigated and suctioned. Excellent hemostasis was noted.
All instrumentation was removed and gas was expelled from the abdomen. An 0 Polysorb interrupted suture was placed in the fascia below the subumbilical incision. The subumbilical skin incision was closed with 3-0 Polysorb subcuticular running suture. The lower skin incisions were approximated with Steri-Strips. All skin incisions were infiltrated with 0.5% Marcaine with epinephrine 1:200,000. Dressings were applied with paper tape. The sponge stick was removed from the vagina. The patient was returned to supine position and awakened from anesthesia. She was cleaned, undraped, and taken to recovery in satisfactory condition.
NEEDLE & SPONGE COUNTS: Needle and sponge count was reported as correct.
ESTIMATED BLOOD LOSS: Minimal.
SPECIMENS: Right and left ovaries, distal fallopian tubes.
DRAINS & PACKS: Foley catheter.
PROGNOSIS: Prognosis immediate and remote are good.