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MEDICAL FACULTY OF CHRISTIAN UNIVERSITY OF INDONESIA GENERAL HOSPITAL DEPARTMENT OF OBSTETRY AND GINECOLOGY JL. Mayjen Sutoyo No. 2 Cawang, Jakarta Timur 13630 Telp.8099217 ext. 108 / 205

SURGERY REPORT
Name: Mrs. Norsyabaniah Sex: Female Operator Prof. Dr. H. I. O.Marsis, SpOG Anestetic Asistant 1 Dr. Benhur Sibuea Instrumentator Asistant 2 Happy Martha M. Nababan Observer Pre-surgery diagnose: Myoma uteri with history of metrorhagia Post- surgery diagnose: Myoma uteri + adhesion Technique of operation 1. Total hysterectomy 2. 3. Age: 42 years old Dr. Ratna, SpAn Zr. Lina Quintina Paramina Gadroen Surgery date: April 26st 2013 Duration time of surgery: 2 hours Type of surgery emergency minor policlinic medium elective major

Operation Procedures: I. II. III. IV. Patient in supine position with general anesthetic Applying methylene blue into introitus vagina and installing dower catheter Asepsis and antisepsis in abdomen region and surrounding the 1/3 distal of posterior extremity, field of view narrowed by steril doek. Opened the abdominal wall. a. Pfannensteil incision was made around fibritio tissue, 15 cm length, the incision was made deeper slice by slice from cutis, subcutis, fascia then it seperated to lateral section with sharp technique. Musculus rectus abdominis seperated with dull technique, bleeding was taken care off. b. Identified: -The uterine as big as adult punch hand and looked adhesion with peritoneal -Left and right ovary looked normal -The right and left fallopian looked normal Conclusion: Myoma uterine with adhesi Total hysterectomy + adhesiolysis was planned. c. Applying hashbach in to abdominal cavity to separating uterus with other organ.

d. Found uterus approximately like adult punch hand, consistency hard. e. Fixation uterus by uterus extractor. f. The proximal of left fallopian tube, left broad ligament and left round ligament was clamped on two side, approximately 1cm and 1,5 cm from uterus. Then cut both two clamp, ligated at medial and lateral dissection and then sutured it by Vicryl no.1. The same procedure is done on the right fallopian tube, right broad ligament and round ligament. g. Opened plica vesikouterina and continued incision to the left and right lateral and put aside to lower. h. The left uterosacral ligament clamped on two side, approximately 1 cm and 1,5 cm from uterus, cut between two clamped, ligated on medial and lateral dissection then sutured with Vicryl no.1. The same procedure is done on the right uterosacral ligament. i. The left and right vasa uterina clamped, cut and ligated with Vicryl no.1 j. The left cardinale ligament clamped on two side, cut between two clamped, ligated on medial and lateral dissection, then sutured. The same procedure is done on the right cardinale ligament. k. Cut off the upper vagina and sutured with Vicryl no.1 by overhecting suture. And hanged with the right and left round ligament, the right and left uterosacral ligament and the proximal of right and left fallopian tube. l. Uterine tissue obtained as adult punch hand. Uterine extractor remove from the uterine. m. Reperitonealitation by sutured plica vesikouterin with Chromic Cat Gut no.2.0 V. VI. Removal or surgical seperation of adhesion between peritoneal and uterus (adhesiolysis) After the reperitonealitation and adhesiolysis had been done, abdominal wall was closed, the peritoneum cavity was cleared from the blood cloth and after sure its no bleeding then it was sutured slice by slice. a. Peritoneum parietal was sewed continuously with Plain cat gut no.2.0, before that the dexamethasone was pulled in. b. M. Rectus abdominis was sutured with Chromic cat gut no.2.0 by continuously

c. Fascia was sutured with Vicryl no.1 by continuously. d. Subcutis was sutured with Plain cat gut no.0 by simple suture e. Cutis was sutured with Chromic cat gut no. 3.0 by subcuticuler VII. VIII. IX. Post surgical wound was cleaned by using Nacl, and then it was closed by using the curapor. The vagina was cleaned. The surgery finished.

Post surgery condition: General condition Consciousness Blood pressure Pulse rate Respiratory Rate Temperature : Moderate illness : Somnolent : 110/70 mmHg : 75x/mnt : 18x/mnt :36,4 oC

Tissue to Anatomy Patological Yes: type of tissue : uterus (April 26st 2013) No

Operator,

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