Laparoscopic Tubal Fulguration with Bipolar Cautery
After administration of general anesthesia, the patient was placed in the dorsolithotomy position and examination under anesthesia performed with findings as noted above. The patient was prepped and draped in the usual sterile fashion. The bladder was drained with a straight catheter, and a speculem placed into the vagina to visualize the cervix. A single tooth tenaculum was placed on the anterior lip of the cervix, and the Kahn cannula placed into the cervical os. The cannula articulated to the tenaculum and the speculum removed from the vagina. The perineum was draped off from the abdominal field.
A 1cm horizontal infraumbilical incision was made. A Verres needle was inserted through the incision and its correct intraperitoneal position was confirmed using the saline drop method. A pneumoperitoneum was established by insufflating the abdomen with approximately 3 liters of CO2 with an opening pressure of 4-5 mm of Mercury. The Verres needle was removed and the laproscopic sheath and trocar placed into the abdominal cavity. The trocar was removed and the laparoscope inserted. A 5mm accessory trocar and sheath were placed under direct visualization through a stab incision two fingerbreaths above the pubic symphysis in the midline. The abdomen and pelvis were examined with findings as noted above.
The left fallopian tube was grasped approximately 3cm from the left cornu and fulgurated using bipolar cautery. Two contiguous areas of the tube distal to the initial site were also cauterized, with fulguration noted to extend into the mesosalpinx. The right fallopian tube was similarly fulgurated in three contiguous areas, beginning approximately 3cm from the right cornu, with extension of the fulguration into the mesosalpinx.
The accessory sheath and cautery were removed under direct visualization, and the pneumoperitoneum evacuated. The laparoscope and sheath were withdrawn, and the skin edges reapproximated using interrupted #4.0 Vicryl. The instruments were removed from the vagina, and the patient recalled from general anesthesia without difficulty. The sponge and needle counts were correct. Estimated blood loss was less than 20cc. There were no complications.
Disposition: The patient will be discharged to home later today when awake and alert. Discharge medications include Tylenol #3 and Motrin as needed for pain.
C/S | Post-Partum Tubal Ligation, Pomeroy | Total Abdominal Hysterectomy/Bilateral Salpingoophorectomy/Appendectomy/Burch | Vaginal Hysterectomy and Anterior Repair