Laparoscopic Bilateral Tubal Ligation 1

Laparoscopic Bilateral Tubal Ligation Operative Report
Preoperative Diagnosis: Multiparous female desiring permanent sterilization. Postoperative Diagnosis: Same as above Title of Operation: Laparoscopic bilateral tubal ligation with Falope rings Surgeon: Assistant: Anesthesia: General endotracheal Findings At Surgery: Normal uterus, tubes, and ovaries. Description of Operative Procedure After informed consent, the patient was taken to the operating room where general anesthesia was administered. The patient was examined under anesthesia and found to have a normal uterus with normal adnexa. She was placed in the dorsal lithotomy position and prepped and draped in sterile fashion. A bivalve speculum was placed in the vagina, and the anterior lip of the cervix was grasped with a single toothed tenaculum. A uterine manipulator was placed into the endocervical canal and articulated with the tenaculum. The speculum was removed from the vagina. An infraumbilical incision was made with a scalpel, then while tenting up on the abdomen, a Verres needle was admitted into the intraabdominal cavity. A saline drop test was performed and noted to be within normal limits. Pneumoperitoneum was attained with 4 liters of carbon dioxide. The Verres needle was removed, and a 10 mm trocar and sleeve were advanced into the intraabdominal cavity while tenting up on the abdomen. The laparoscope was inserted and proper location was confirmed. A second incision was made 2 cm above the symphysis pubis, and a 5 mm trocar and sleeve were inserted into the abdomen under laparoscopic visualization without complication. A survey revealed normal pelvic and abdominal anatomy. A Falope ring applicator was advanced through the second trocar sleeve, and the left Fallopian tube was identified, followed out to the fimbriated end, and grasped 4 cm from the cornual region. The Falope ring was applied to a knuckle of tube and good blanching was noted at the site of application. No bleeding was observed from the mesosalpinx. The Falope ring applicator was reloaded, and a Falope ring was applied in a similar fashion to the opposite tube. Carbon dioxide was allowed to escape from the abdomen. The instruments were removed, and the skin incisions were closed with #3-O Vicryl in a subcuticular fashion. The instruments were removed from the vagina, and excellent hemostasis was noted. The patient tolerated the procedure well, and sponge, lap and needle counts were correct times two. The patient was taken to the recovery room in stable condition. Estimated Blood Loss (EBL): <10 cc Specimens: None Drains: Foley to gravity Fluids: 1500 cc LR Complications: None Disposition: The patient was taken to the recovery room in stable condition.

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2 Postpartum Tubal Ligation Operative Report

Postpartum Tubal Ligation Operative Report
Preoperative Diagnosis: Multiparous female after vaginal delivery, desiring permanent sterilization. Postoperative Diagnosis: Same as above Title of Operation: Modified Pomeroy bilateral tubal ligation Surgeon: Assistant: Anesthesia: Epidural Findings At Surgery: Normal fallopian tubes bilaterally Description of Operative Procedure: After assuring informed consent, the patient was taken to the operating room and spinal anesthesia administered. A small, transverse, infraumbilical skin incision was made with a scalpel, and the incision was carried down through the underlying fascia until the peritoneum was identified and entered. The left fallopian tube was identified, brought into the incision and grasped with a Babcock clamp. The tube was then followed out to the fimbria. An avascular midsection of the fallopian tube was grasped with a Babcock clamp and brought into a knuckle. The tube was doubly ligated with an O-plain suture and transected. The specimen was sent to pathology. Excellent hemostasis was noted, and the tube was returned to the abdomen. The same procedure was performed on the opposite fallopian tube. The fascia was then closed with O-Vicryl in a single layer. The skin was closed with 3-O Vicryl in a subcuticular fashion. The patient tolerated the procedure well. Needle and sponge counts were correct times 2. Estimated Blood Loss (EBL): <20 cc Specimens: Segments of right and left tubes Drains: Foley to gravity Fluids: Input - 500 cc LR; output - 300 cc clear urine Complications: None Disposition: The patient was taken to the recovery room in stable condition.

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