No.

MR
SURGERY REPORT
Name : Mrs. Tiarli Gultom Sex : Female Age : 33 Years
Operator Prof. Dr. H.I.O Marsis SpOG A!est"eti# $liff $a%ra&ala
Assisterr! 'osia!a $a!(ra )lie Par(osi I!strume!tator *(. Na!#+
O,ser-er $liff $a%ra&ala O,ser-er . /
Pre/surgi#al Diag!ose : Primar+ I!fertilit+
Post/surgi#al Diag!ose : Pate!t Fallopia! Tu,e Surger+ Date : 0ul+ .
t"
.123
Duratio! time of surger+ : 21 mi!utes
Te"!i3ue of operatio! : T+pe of surger+
2. H+(rotu,atio! 4 5merge!#+ 4 Mi!or
.. 4 Poli%li!i% Me(ium
3. 5le%tif 4 Ma+or
Operatio! Pro#e(ures:
2. O!e "our ,efore "+(rotu,atio! i!6e#te( 17mg of Sulfas Atropi! i!tra mus#ular.
.. Patie!t slept supi!e o! operatio! ta,le &it" lit"otom+ positio! O
.
!asal . lpm &it" ge!eral
a!aest"eti# 89etalar 31mg a!( Dia:epam 21mg i!tra -e!ous;
3. Asepti# a!( a!tisepti# at exter!al ge!ital regio! a!( arou!(. Applie( steril (oe% at ,ot" of legs
a!( operatio! fiel( area.
<. Applie( sims spe#ulum at posterior -agi!a. A!terior portio #lampe( &it" %o"el ta!g at 2.
o=#lo#% positio!.
7. Measure t"e uterus &it" uter+ so!(e a!( got >#m.
?. )teri!e #a!ul &as i!serte( i!to uteri!e #a-it+ a!( t"e! .1 ## of a3ua,i(es @ 9a!ami#+! 2gr @
Ora(exo! 7mg &as i!6e#te( i!to t"e uteri!e #a-it+ troug" t"e uteri!e #a!ul a!( fou!( !o
pressure.
>. T"e result &as pate!t fallopia! tu,e.
A. T"e uteri!e #a!ul "a( ,ee! release(. Put off t"e %o"el ta!g a!( posterior spe#ulum sims.
B. $lea!e( t"e exter!al ge!italia &it" sterile %assa a!( ,eta(i!e.
21. Hi(rota,atio! fi!is"e(

10 44 04 00
M5DI$AC FA$)CTY OF $H'ISTIAN )NID5'SITY OF
INDON5SIA G5N5'AC HOSPITAC
D5PA'TM5NT OF O*ST5T'Y AND GIN5$OCOGY
0C. Ma+6e! Suto+o No. . $a&a!g 0a%arta Timur 23?31
Telp.A1BB.2> ext. 21A E .17
T"e #o!(itio! of patie!t post operatio!:
Ge!eral #o!(itio! : Coo% mil( si#%
$o!s#iou!ess : $ompos Me!tis
*loo( pressure : 2.1EA1 mmHg
Pulse rate : A? xEmi!ute
'espiratio! : .1 xEmi!ute
Temperature : 3??
o
$
Tissue to Pat"olog+ of A!atom+ :
4 Yes
No
Operator
8Prof. (r. H.I.O Marsis SpOG;