Patient Name: _______________
Patient ID: _______________
Date: _______________
Operation: Operative Hysteroscopy with loop and RollerBall Ablation for treatment of menorrhagia

Surgeon: _______________
Assistants: _______________
Anethesia: General anesthesia with endotrachial tube
Anesthesiologist: _______________
Pre-Op Diagnosis: Menorrhagia
Post-Op Diagnosis: Same
Procedure: Hysteroscopy and rollerball endometrial ablation
Operative Findings:
  1. Normal bimanual exam, anteverted uterus. No adnexal massess palpable
  2. Normal uterine cavity, no abnormal structures, polyps, or fibroids idenitified. Normal tubal ostia bilaterally
Estimated Blood Loss: Minimal
Glycine Defecit: _______ cc
Complications: None.

Clinical Note: Ms. _______________ is a 45 year-old female who presented to ________ for a scheduled ablation due to ongoing menorrhagia. She had previously consented to the procedure in Dr. _____'s office and understands the nature of the operation as well as the possible risks/complications (notably infection, hemorrhage, perforation with possible injury to other organs/structure). Consent was given today and has been previously signed in the office.

Procedure: Under general anaesthetic in the dorsal lithotomy position, the patient was prepped and draped in the usual sterile manner. Bimanual exam prior to prepping revealed a mobile, anteverted non-enlarged uterus. A weighted speculum was placed in the vagina and with the help of a right angle retractor the anterior lip of the cervix was grasped with a single toothed tinaculum and brought forward. A paracervical block was performed using 0.50% lidocaine with 1:200,000 of epinephrine, injecting 2cc into the 2, 4, 8, and 10 o'clock locations of the cervix for a total of 8 mL. A sound was then gently inserted to reveal a depth of approximately 10 cm. Following this, the cervix was dilated with progressively larger Hagar dilators to a size #10.

The operative hysteroscope with the loop attachment was then inserted into the cervical canal slowly introduced into the endometrial cavity. Glycine was used for distention. And the coagulation setting for electrocautery was set at 80. The endometrial lining looked normal in apperance and both ostia were seen at the upper lateral aspects of the uterine cavity. No polyps or submucusal fibroids were noted. After appropriate visualization and distention with glycine, the loop device was used with the caudery setting to curette the endometrial lining. Beginning with the fundus, followed by the posterior, lateral, and then anterior walls, all regions were passed ensuring the remaining endometrium was white and no pink endometrium was left behind. A few additional spot burns were performed to ensure hemostasis. The fragments of endometrial tissue were then removed and sent for pathology.

Following this first step, the operative hysteroscope was then reintroduced with the rollerball device attachement. Again, all surfaces of the endometrium were ablated begining at the fundus and moving posteriorly, always in a distal to proximal fashion. This process was repeated in sequential strips until a golden brown texture was obtained. The lateral and anterior walls of the endometrial cavity were then ablated in turn in the same manner. This was continued down until the level of the inner os of the cervix. There was minimal bleeding. Finally, both ostia were spot burned briefly to ensure complete ablation. Once a golden brown colour was achieved for the entire uterine cavity, the instruments were removed from the endometrial cavity. (There was some bleeding from the anterior lip of the cervix at the tinaculum site for which ring forceps was applied temporarily until hemostasis was achieved.) All instruments were removed from the vagina and bleeding was minimal. Total EBL was less than 25 ml. Net glycine loss was 400ml with a significant quantity of this being lost onto the floor due to loss fitting hysteroscope tubing). At the end of the procedure all sponge and instrument counts were correct. The patient was then transported to the recovery room in stable condition. There were no complications.