Laparoscopic Tubal Ligation

 

PREOPERATIVE DIAGNOSIS: *** yo G***P*** who desires permanent sterilization

POSTOPERATIVE DIAGNOSIS: Same

PROCEDURE: Laparoscopic bilateral tubal ligation

SURGEON: ***

ASSISTANT: ***

ANESTHESIA: General endotracheal tube anesthesia

ESTIMATED BLOOD LOSS: <50 cc

URINE OUTPUT: ***

INTRAVENOUS FLUIDS: ***

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INDICATIONS: *** yo G***P*** who desires permanent sterilization. She understands this procedure is not reversible and any future fertility would be achieved through in-vitro fertilization. Patient was consented in compliance with state laws.

 

FINDINGS: There was a normal sized anteverted uterus that sounded to a depth of ***cm. There were normal tubes and ovaries bilaterally. There was a normal uterus. There were normal anterior and posterior cul-de-sacs. There was no evidence of adhesions. There was no evidence of endometriosis. There was a normal appearing liver edge.

 

PROCEDURE: The patient was met in pre-operative holding where consents were reviewed and the patient was firm in her decision making regarding permanent sterilization. The patient was taken to the Operating Room, intermittent compression devices were placed on her calves bilaterally and she underwent general endotracheal tube anesthesia. She was then prepped and draped in the usual, sterile fashion in the dorsal lithotomy position. Examination under anesthesia revealed the findings as noted above. A weighted speculum was then placed in the posterior fornix of the vagina and a Sims speculum was placed along the anterior wall of the vagina. A single tooth tenaculum was then placed on the anterior lip of the cervix. The uterus was then sounded to a depth of ***cm and a Humi uterine manipulator was then inserted into the uterus and inflated. All instruments were then removed from the cervix and vagina.

 

Attention was then turned to the abdomen where a 5 mm transverse umbilical skin incision was made with a scalpel. A Veress needle was then inserted through this incision without difficulty. The CO2 gas was then applied with opening pressures noted to be 0 mmHg. High flow was turned on and pneumoperitoneum was obtained. A 5 mm trocar was then inserted without difficulty. The camera was inserted with findings as noted above

 

A 5mm port was then inserted into the ***LLQ under direct visualization. A Kleppinger forceps was then inserted through this trocar and the right tube was identified and followed out to the fimbriae. A 3cm portion of the tube was cauterized in the mid portion of the tube with good hemostasis noted. Attention was then turned to the left tube which was identified and followed out to the fimbria. A 3 cm portion of the tube was cauterized in the mid portion of the tube with good hemostasis noted. All instruments were then removed from the abdomen with good hemostasis noted. The skin at both trocar sites was closed with #4-0 Biosyn in a subcuticular fashion. Good hemostasis was noted. The patient tolerated the procedure well and was taken to the Recovery Room in stable condition. Sponge, needle, instrument counts correct x 3.