Abdominal Myomectomy

 

Patient Name: ***

MRN: ***

Procedure Date: ***

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PREOPERATIVE DIAGNOSIS: *** 

POSTOPERATIVE DIAGNOSIS: same

PROCEDURE: Abdominal myomectomy.

SURGEON: ***

ASSISTANT: ***

ANESTHESIA: General endotracheal.

ESTIMATED BLOOD LOSS: *** cc via foley catheter

URINE OUTPUT: *** cc via foley catheter

IV FLUIDS: *** cc via foley catheter

 

PREOPERATIVE INDICATIONS: *** year old G***P*** with *** who desires surgical management. 

FINDINGS: ***

*** THE PATIENT SHOULD NOT LABOR GIVEN THE DEPTH AND EXTENT OF UTERINE WALL DISSECTION.

 

PROCEDURE IN DETAIL: 

The patient was met in pre-procedure holding where consents were reviewed with the patient and reviewed the risks/benefits/indications for the procedure including the risk of blood loss requiring transfusion, infection, damage to the uterus requiring cesarean delivery and the implications for future pregnancies. *** She was given pre-operative heparin, tylenol and gabapentin and had a skin prep with SAGE cloths prior to her procedure.

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The patient was taken to the operating room where SCD devices were applied to her calves, she was given general anesthesia, prepped and draped in supine position. A ***Pfannenstiel skin incision was made with a knife, carried down sharply at the level of the fascia. The fascia was incised in the midline, extended laterally with scissors. The rectus muscles were gently separated and the peritoneum was entered sharply. The peritoneal incision was extended superiorly and inferiorly with care taken to avoid the bladder. The uterus could be visualized. There were no adhesions around the uterus. ***The fallopian tubes and ovaries were within normal limits. The uterus was ***able to be mobilized through the abdominal incision.

 

Attention was turned to the *** fibroid and dilute vasopressin solution of 20 units in 100 mL was injected at the serosa overlying the largest fibroid. An incision was made with monopolar cautery down to the level of the fibroid and was removed with blunt and sharp dissection. ***There were multiple additional fibroids removed through ***. The incisions were closed in multiple layers using Vicryl suture. The serosal stitch was closed with a 3-0 Vicryl suture placed in a baseball suture manner.  ***This procedure was repeated on ***. In total, *** fibroids removed from the patient's uterus. 

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***The fallopian tubes and ovaries were not impinged upon with the surgical tubing. At the conclusion of the procedure, the tubing was loosened. Adequate hemostasis was assured. The uterus was returned to the abdomen. The subfascial spaces were inspected for hemostasis. The fascia was closed with a running ***0 Vicryl  suture. Subcutaneous tissues were irrigated and found to be hemostatic and subcutaneous tissues were reapproximated with ***running 2-0 plain gut suture. The skin incision was closed with a subcuticular 4-0 Biosyn suture. Sterile dressings were applied. The patient tolerated the procedure well and was taken to recovery room in stable condition. There were no intraoperative complications.