Date: _______________
Surgeon: _______________
Assistant(s): _______________
Anesthesia: GA with ET tube
Anesthesiologist: Dr. _______________
PreOp Dx: _______________
PostOp Dx: _______________
Operation: Total Abdominal Hysterectomy with Bilateral Salpingooophorectomy
Operative Findings: Thin anterior lower segment

Clinical Note: Ms. _______________ is a...

Under (spinal/epidural/general) anaesthetic the patient was placed in the supine position. Examination under anesthesia showed the uterus to be small, mobile and anteverted. With a foley catheter inserted, the patient was prepped and draped in the usual sterile fashion. A (Pfannensteil/midline) incision was made (through the patient’s previous incision). The incision was carried down to the fascia with (sharp dissection/cautery). The fascia was incised transversely and dissected off the rectus muscle using (blunt/sharp) dissection. Electrocautery was used for hemostasis. The peritoneum was opened taking care not to injure any underlying structures. Laparotomy revealed no obvious abnormalities. (IF for CA comment on pelvic washings, evidence of mets like enlarged periaortic nodes).
A Balfour retractor was placed and the bowel was packed away into the upper abdomen to improve visualization and protect adjacent tissue. The uterus itself appeared small and mobile. (There were some filmy adhesions in the area of X which were taken down using sharp dissection). The tubes and ovaries appeared normal bilaterally. The cornea were grasped using (Rochester clamps-curved Kelly clamps) and the uterus elevated. The round ligament on the left was grasped and divided using cautery and then suture ligated. The peritoneum was opened lateral to the infundibulopelvic ligaments. The anterior leaf of the broad ligament was divided and a bladder flap created. The retroperitoneal space was then dissected out. The ureters were identified and found to be well low in the pelvis and clear of the surgical field. An avascular window was found in the posterior leaf of the broad ligament and a hole opened. The (infundibulopelvic or uteroovarian) ligament was clamped, cut and double ligated. The same procedure was carried out on the right with the ureter again found to be well low in the pelvis and clear of the surgical field.
Once the anterior leaf of the broad ligament was completely divided the bladder was taken down off the lower segment of the uterus and the cervix using (cautery-blunt dissection). The uterine vessels were skeletonized bilaterally. The uterine vessels were bilaterally clamped, cut and suture ligated. The cardinal ligaments were bilaterally clamped, cut and suture ligated. The uteroscral ligaments were bilaterally clamped, cut and suture ligated. (1 further pedicle was required to enter the vagina which was C,C, SL). The cervix was then divided sharply from the vagina. (The uterus, tubes , ovaries and cervix were all sent to pathology.) Both corners of the vaginal vault were secured and the vault was closed with a running locking suture (or the ant and post cuffs were whip stitched and a single figure of eight suture used to reapproximate the vault). All pedicles were then sequentially checked for hemostasis which appeared excellent.
The bowel pack was then removed and the omentum and small bowel were assessed for injury and hemostasis.

Special: Omental Biopsy

The omentum wasbrought down and splayed open. The omentum was then sequentially clamped transversely with multiple snaps. The isolated omental fragment was cut free with mayo scissors and sent for pathology. With each snap, a vicryl suture was wrapped around the snap, tied and cut. The snap was then removed and the pedicle was assessed for hemostasis. This was repeated until all the snaps were removed.

All packs and retractors were removed from the abdomen. The peritoneum was closed using a running vicryl suture. The subfascial space was inspected and hemostasis obtained with cautery. The fascia was closed using a running, non-locking suture. Subcutaneous tissue was inspected and hemostasis ensured with cautery. The skin was closed with a running subcuticular suture.
At the end of the procedure all sponge, needle and instrument counts were correct. Estimated blood loss was (500) ml. The patient was extubated and taken to recovery in stable condition.