No.

MR

03

20

16

OBSTETRIC AND GINECOLOGY DEPARTEMENT

BUDHI JAYA MOTHER AND CHILDHOSPITAL
JL. Dr. Sahardjo No. 120 Jakarta Selatan 12960
Telp. (021) 8292672, 8311722, 8312378
Fax. 8301901

SURGERY REPORT
Nama : Mrs. Nunung
Operator
Prof. Dr. H.I.O Marsis, SpOG
Asisten
Toby Hadinata W.

Sex : Female
Anesthetic
Instrumentator
Observer
Pre-surgical Diagnose : Primer Infertility + Susp. Tube occlusion
Post-surgical Diagnose : Bilateral tubes patent

Tehnique of operation :
1. Hydrotubation

Age : 41 Years
dr. Widodo, SpAn

Surgery Date : March 21th 2016

Duration time of surgery :
15 minutes
( 20.15 20.30 )
Type of surgery
Emergency
Minor
Poliklinik
Medium
Mayor
Elektif

Operation Procedures:
I.

Patient was administrated with general anesthesia in lithotomy position

II.

Aseptic and antiseptic were done on genital area and the operation field was limited with sterile doek

III.

Operation procedures of hidrotubation followed :

a.

Applied sims speculum posterior and anterior speculum to vagina. Portio clamped with Kohel
tang at 12 hour direction.

b.

Removed anterior sims speculum.

c.

Sondation 7 cm anteflexion uterine.

d.

Hidrotubator was inserted into uterine cavity and then 20 cc of NaCl 0,9% + Kanamycin 1 gr
was injected into the uterine cavity through the uterine canul. No leak of liquid detected in the
sims speculum and no obstruction, so the conclusion is the both fallopian tube is passable.

e.

The uterine canul had been released, the Kohel tang and sims speculum had been released

IV.

Aseptic and antiseptic at external genital region

V.

The vagina was cleaned

VI.

The operation finished

The condition of patient post operation:
General condition

: Look mild sick

Consciouness

: Compos Mentis

Blood pressure

120/80

Pulse rate

88 x/minute

Respiration

22 x/minute

Temperature

36,6oC

mmHg

Tissue to Pathology of Anatomy :

Yes
No

Operator,

(Prof. dr. H.I.O Marsis, SpOG)