daVinciSCH_BSO

DATE OF SURGERY: 05/23/2026 11:10 PM
PRE-OP DIAGNOSIS: Leiomyoma Uteri
POST-OP DIAGNOSIS: Leiomyoma Uteri
PROCEDURE: daVinci Laparoscopic Supracervical Hysterectomy/BSO
EBL: Minimal
SPECIMENS: Uterus, Fallopian Tubes, and Ovaries
CONDITION: excellent

Description of procedure

The patient was brought to the operating room and general endotracheal was initiated. The patient was then prepped and draped in the usual sterile fashion in the dorsal lithotomy position with Allen stirrups. The time out safety protocol was called out by the surgeon and affirmed by all personnel present. A uterine manipulator was then placed in the uterus without difficulty. An 8mm umbilical incision was made, and the verres needle was used to create a pneumoperitoneum. An 8mm trocar was then placed without difficulty. The camera was then introduced, and the pelvis was inspected with the findings as described above. Two 8mm lateral ports were placed, a 12mm lateral assistant port, and a 3rd arm 8mm port was placed all under direct visualization without difficulty. The patient was placed in trendelenburg. The daVinci patient cart was then docked in the usual manner without difficulty. Bipolar graspers and monopolar endoshears were introduced under direct visualization. The surgeon then moved to the surgeon console. The harmonic scalpel and/or endoscopic shears were used to lyse the adhesions as described in the findings. Good hemostasis was confirmed. The left adnexa was then elevated with an atraumatic grasper. The ureter was visualized transperitoneally and noted to be peristaltic and well away. The bipolar and monopolar cautery with than used in a coordinated fashion to coagulate and cut the infundibulo-pelvic ligament. The Broad ligament and the round ligament where taken down up to but not through the uterine vessels. Good hemostasis was ensured. The same was performed on the opposing side without difficulty. The bladder flap and rectovaginal spaces were then developed with blunt and sharp dissection. The uterine vessels were then coagulated and cut. The monopolar endoshears were then used excise the uterus supra cervically. The uterus was then placed in the upper abdomen out of the way for subsequent removal. A vaginal stent was used to elevate the vagina, and an EEA was placed in the rectum to assist in identifying the planes of dissection. The bladder flap and rectovaginal spaces were then developed with blunt and sharp dissection. The sigmoid colon was then retracted laterally to provide exposure. The peritoneum over the sacral promontory was then incised, and then extended down to the vagina to facilitate exposure of the Anterior Longitudinal Ligament. The fat pad was dissected, and small vessels were coagulated as necessary. The Polypropylene mesh was than introduced, and the anterior flap was sutured to the anterior vaginal wall with CV-2 Gore-Text with 4 to 8 sutures. The posterior mesh was then secured similarly. The Y-shaped mesh assembly was than secured to the Anterior Longitudinal Ligament with 3 sutures, ensuring good suspension with excess tension. The mesh was then re-peritonealized using 2-0 Vicryl. The morcellator was then used to remove the uterus and ovaries without difficulty. All pedicles were re-inspected and noted to be hemostatic under reduced intra abdominal pressure. Again, the ureters were visualized transperitoneally and noted to be peristaltic and well away from the surgical sites. The patient cart was then undocked from the patient and the ports were removed. The port sites were re-closed using 4-0 Vicryl, and 2-0 Vicryl on the fascia for the larger port sites. Two Alice clamps were used to grasp the anterior vaginal mucosa. Central injection with xylocaine and epinephrine was then performed. Strully scissors were used to create central incision, and dissect the vaginal mucosa away from the underlying tissue. Pratt clamps were used on the vaginal mucosa. The underlying tissue was then imbricated using interrupted 2-0 Vicryl. The excess vaginal mucosa was trimmed and sent to pathology. The mucosa was then reapproximated with a running locking stitch. Two alice clamps were used to grasp the posterior vaginal mucosa on each opposing side. Central injection with xylocaine and epinephrine was then performed. Strully scissors were used to create central incision, and dissect the vaginal mucosa away from the underlying tissue. Pratt clamps were used on the vaginal mucosa. The underlying tissue was then imbricated using interrupted 2-0 Vicryl, including plication of the levators. The excess vaginal mucosa was trimmed and sent to pathology. The mucosa was then reapproximated with a running locking stitch. Normal vaginal caliber and length were confirmed. Two allice clamps were used to grasp the posterior vaginal mucosa on each opposing side. A central injection with xylocaine and epinephrine was then performed. Strully scissors were used to create a central incision, and dissect the vaginal mucosa away from the underlying tissue. Lateral vaginal wall retractors were used to aid in exposing the sacro spinous ligament. The Capio suture passer was then used to place a 0-prolene suture in the ligament. The other end was sutured to the vaginal apex, and the tied down, elevating the vaginal apex. Good hemostasis was confirmed. Any excess vaginal mucosa was trimmed and sent to pathology. The mucosa was then reapproximated with a running locking stitch. Normal vaginal caliber and length were confirmed Two allice clamps were used to grasp the para urethral tissue, and the sub-urethral tissue was incised with a scalpel. The lateral urethral space was the exposed with blunt and sharp dissection. A trans urethral stent was placed in a foley catheter, and placed in the urethra for lateral deflection to reduce the chance of injury during trocar placement. The vaginal tape and trocars where assembled and prepared for placement. The trocar was then placed lateral to the urethra, and a stab incision on the mons pubis allowed passage of the trocar. The same was performed on the other side without difficulty. Cystocopy was then performed to insure the bladder was intact. The trocars was then removed, leaving the tape under the urethra in a tension free position. The positioning was aided using the mayo scissors as a spacer under the urethra. The excess tape was trimmed on the mons. The skin incisions where reapproximated with 4-0 Vicryl and or steri strips. The vaginal mucosa was reapproximated using 2-0 Vicryl, and a foley catheter was anchored. Good urethral support was confirmed. The patient was then brought out of anesthesia and transferred to the recovery room in excellent condition.

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