PREOPERATIVE DIAGNOSIS: Left ovarian cyst.
POSTOPERATIVE DIAGNOSIS: Left ovarian cyst.
NAME OF PROCEDURE: Laparoscopic left ovarian cystectomy.
SURGEON: John Doe, MD
ANESTHESIA: General endotracheal.
SPECIMEN: Left ovarian cyst.
FINDINGS: Normal right ovary and uterus. Left ovarian cyst.
ESTIMATED BLOOD LOSS: 50 mL.
COMPLICATIONS: None.
POSTOPERATIVE CONDITION: Good condition to PACU.
DESCRIPTION OF PROCEDURE: The patient was taken to the operating room where general endotracheal anesthesia was introduced for laparoscopic left ovarian cystectomy. The patient was prepped and draped in normal sterile fashion. The bladder was catheterized.
Subsequently, the cervix was grasped with a single-toothed tenaculum, and a uterine manipulator was inserted. Attention was turned to the laparoscopic part of the procedure.
A 1 cm incision was then made below the umbilicus. A 5 mm trocar was inserted under direct visualization. Subsequently, the abdomen was insufflated with carbon dioxide up to a pressure of 15 mmHg.
The pelvic anatomy was inspected. The uterus was normal as well as the right ovary. The left ovary had a large ovarian cyst about 6 x 4 x 4 cm. At this point, the decision was made to proceed with a laparoscopic left ovarian cystectomy, presumed some of the normal ovarian tissue. A 5 mm port was then placed and under direct visualization, two other 5 mm ports were placed in the right lower quadrant and left lower quadrants under direct visualization. The skin over the mucosa was injected with 10 mL of 0.5% Marcaine.
At this point, the ovarian cyst was grasped with a nontraumatic grasper and laparoscope scissors were used initially when attempting to do the cystectomy. At this point, a window was made into the left ovarian cyst.
At this point, we noticed that clear follicular fluid was being extruded from the cyst, thus deflating the cyst. At this point, we decided to remove the cyst wall from the normal ovarian tissue with the help of a ligature device.
Subsequently, the ovarian cyst wall was grasped with the ligature, cauterized and cut. This was continued until the cyst wall was freed from the normal ovarian tissue. Hemostasis was noted over the pedicles.
At this point, the endoloop device was used to remove the cyst wall. Since we had all 5 mm ports, we decided to extend the skin incision on the subumbilical port to be able to insert the 5 mm trocar. This was done under direct visualization.
The endoloop was inserted. The cyst wall was then inserted into the endoloop, which was then removed without difficulty. The pelvis and the pedicles were irrigated with normal saline and suction was applied. Hemostasis was noted.
At this point, the laparoscopic left ovarian cystectomy was deemed complete. All ports were removed and all of them under direct visualization. Carbon dioxide was removed from the abdomen. The fascia at the subumbilical port was closed with 0 Vicryl suture. The skin was approximated with 4-0 Monocryl suture. The other incisions were approximated with 4-0 Vicryl suture and Dermabond was placed over these incisions.
Sponge, lap and needle counts were correct x3. The patient tolerated the laparoscopic left ovarian cystectomy well.
