Scenario Six- | |
OPERATION: Da Vinci assisted total laparoscopic hysterectomy with bilateral salpingectomy and right oophorectomy FINDINGS: Enlarged uterus with multiple fibroids SPECIMEN: Uterus, bilateral fallopian tubes and right ovary weighing 250 g immediately post-op
PROCEDURE: The patient was taken to the operating room where general anesthesia was obtained without any difficulty. The patient was then prepped and draped in the normal sterile fashion in the dorsal lithotomy position. A Foley catheter was placed via their urethra into the bladder and a Fornicee intrauterine manipulator was introduced via the cervical canal into the uterus in the normal manner. An 8 mm supraumbilical skin incision was then made approximately 10 cm above the level of the uterine fundus a Veress needle was introduced through this incision at a 45-degree angle and intra-abdominal placement was confirmed with a positive water drop test. Pneumoperitoneum was obtained with 3L of CO2 gas. The Veress needle was then removed, and an 8 mm trocar and obturator introduced through the same incision at a 45-degree angle under direct visualization. 2 right and 2 left lateral incisions were then made. The more medial of the lateral incisions was made approximately 10 cm lateral to the more medial incisions approximately 3 cm below their level. 8 mm trocars with obturators were introduced through each of these incisions under direct visualization. There was never any contact between the entering trocars and the surrounding viscera. The patient was then placed in steep Trendelenburg with reflex. The da Vinci device was then docked in the normal manner. The round ligaments bilaterally were grasped, ligated, and incised using the vessel sealer device. The anterior leafs of the broad ligament were then incised using the Endoshears and the bladder was bluntly dissected away from the lower uterine segment using the blunt end of the ProGrasp. The right infundibulopelvis ligament was grasped, ligated, and incised using the vessel sealer device. The right broad ligament was grasped, ligated, and incised in multiple steps using the vessel sealer device. The right uterine artery was grasped, ligated, and incised using the vessel sealer device. The left utero-ovarian ligament was grasped, ligated, and incised using the vessel sealer device. The left broad ligament was grasped, ligated, and incised in multiple steps using the vessel sealer device. The left uterine artery was grasped, ligated, and incised using the vessel sealer device. Anterior and posterior colpotomy incisions were then made using the EndoShears. The cardinal ligaments and uterosacral ligaments bilaterally were grasped, ligated and incised using the vessel sealer device. The uterus, bilateral fallopian tubes and right ovary were then delivered via the vaginal incision without difficulty. The vaginal cuff with then reapproximated using the V lock suture in a running nonlocking fashion. The abdomen was then copiously irrigated and cleared of all clots and debris. Hemostasis from all pedicles was noted. FloSeal was then placed on the surgical bed. The da Vinci was then undocked, the patient was flattened out and her pneumoperitoneum was allowed to escape. All trocars were then removed, and the skin of each incision was reapproximated using 4-0 Vicryl in an interrupted fashion. Each incision was infiltrated with 5 mL’s of 5% Marcaine without epinephrine at the procedure’s initiation and another 5 mL’s of 5% Marcaine without epinephrine at the procedure’s conclusion. The vagina was packed with a Betadine and 2% Lidocaine jelly-soaked Kerlix gauze. The patient tolerated the procedure well and all counts were correct. | |
Questions for Scenario Six |
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