Patient Name: _______________
Patient ID: _______________
Date: _______________
Operation: Diagnostic Hysteroscopy with NovaSure Endometrial Ablation

Surgeon: _______________
Assistants: _______________
Anethesia: General anesthesia with endotrachial tube
Anesthesiologist: _______________
Pre-Op Diagnosis: Abnormal Uterine Bleeding
Post-Op Diagnosis: Same
  1. Diagnostic Hysteroscopy
  2. D & C
  3. NovaSure 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
Complications: None.

Clinical Note:
Ms. _______________ is a __ year-old female who presented to the office for abnormal uterine bleeding. Ultrasound imaging did not reveal any submucosal fibroids or polyps. An endometrial biopsy was done which was normal. Conservative therapies including TXA, OCP, and Mirena were discussed/tried. Ultimately, a plan was made to proceed with a novosure endometrial ablation. Risks, potential complications, and benefits were discussed with Ms. _______________ and consent was signed prior to the OR.

Under general anaesthetic in a 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. Taking care not to enter deep into the uterus, a sound was passed inside to measure the length of the uterus and cervix. This legth was found to be _____ cm. Next, a large Hegar dilator was inserted into the cervical os to measure the cervical length which was ____ cm. This yielded an endometrial cavity length of ___. A series of Hegar dilators were then inserted sequentially into the cervical os up to a size of 5 mm. The diagnostic hysteroscope was then introduced into the uterine cavity and the uterus was distended with normal saline fluid. The cavity was examined and found to be normal shape without polyps. Both ostea were visualized. The scope was removed that the cervix was further dilated to 8mm. A curette was introduced into the cavity and a gentle and thorough curettage was performed. The sample was sent to pathology. The novosure device was then opened and tested; the fan deployed easily. The instrument was set to the correct cavity length and introduced into the uterine cavity. The fan was slowly deployed with gentle movements to ensure a snug fit within the cavity. The cavity width read ____. The measurements were imported and a cavity check was done. The trumpet was then slid down to the cervix and the device was activated. The total burn time was _____ seconds and the power was _______. The fan was retracted and device removed. The fan was examined and revealed charred tissue. The tenaculum was removed and the cervix examined for hemostasis which was achieved. Finally the weighted speculum was removed. The patient tolerated the procedure well and was brought to the recovery room in a stable condition. At the end of the procedure all sponges and instruments were counted and correct. The blood loss was minimal and there were no complications.