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DATE OF SURGERY: 05/23/2026 11:07 PM
PRE-OP DIAGNOSIS: Adnexal Mass
POST-OP DIAGNOSIS: Adnexal Mass
PROCEDURE: Laparoscopic Bilateral Salpingo Oopherectomy
EBL: Minimal
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 . The time out safety protocol was called out by the surgeon and affirmed by all personnel present. A sponge stick was placed vaginally. A 5mm umbilical incision was made. . The camera was then introduced, and the pelvis was inspected with the findings as described above. The patient was placed in trendelenburg. suprapubic port and 5mm left lateral port were then placed under direct visualization without difficulty. The left adnexa was then elevated with an Allis grasper. The ureter was visualized transperitoneally and noted to be peristaltic and well away. The harmonic scalpel was then used to coagulate and cut the infundibulo-pelvic ligament. The remaining ovarian pedicle was taken down in a similar manner. The ovary and tube complex were then dropped in the pelvis. The same was performed on the opposing side without difficulty. . All pedicles where re-inspected under low pressure and noted to be hemostatic. The harmonic scalpel and/or endoscopic shears were used to lyse the adhesions as described in the findings. Good hemostasis was confirmed. The implants of endometriosis where fulgurized using a harmonic scalpel. The instruments were then removed, the pneumoperitoneum was evacuated, and the instrument count was correct times two. The incision sites where reapproximated using 2-0 and 4-0 Vicryl. 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. 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 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 candy cane stirrups. The time out safety protocol was called out by the surgeon and affirmed by all personnel present. A weighted speculum was placed in the vagina and retractors were used for visualization. The electrosurgical instrument was then used to excise a cone shaped biopsy from the cervix. The ectocervix was then cauterized using the electrocautery to provide hemostasis and to treat ectocervical dysplasia. Good hemostasis was confirmed. The patient was then brought out of anesthesia and transferred to the recovery room in excellent condition. She was given detailed discharge instructions and plans for follow up. CKC The patient was then brought out of anesthesia and transferred to the recovery room in excellent condition. She was later given detailed discharge instructions and plans for follow up.

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