Operation: Dictation: Laparoscopic Tubal Ligation with Filsche Clips

Date: _______________
Surgeon: _______________
Assistants: _______________
Anethesia: General anesthesia with endotrachial tube
Anesthesiologist: _______________
Pre-Op Diagnosis: Family Planning
Post-Op Diagnosis: Same
Operative Findings:
  1. Normal bimanual exam, anteverted uterus. No adnexal massess palpable
  2. Normal uterus, normal tubes and ovaries bilaterally
Estimated Blood Loss: Minimal
Complications: None.

Clinical Note: Ms. _______________ is a 32 year-old female who has presented for tubal ligation to ensure perminant sterilization. In the clinic, her options regarding the advantages and disadvantages of female sterilization compared with other permanent and nonpermanent, long-acting methods was discussed. Assessment of whether the patient's partner might also consider undergoing sterilization rather than the patient was also had. Risks of surgery (most notably, infection, hemorrhage, and injury to other organs), post-sterilization regret, lack of STI protection, and failure were discussed.

Under GA in the dorsal lithotomy position, the patient was prepped and drapped in the usual sterile fashion. A weighted speculum was placed in the vagina and with the help of a right angle retractor the cervix was visualized and grasped anteriorly with a single tooth tinaculum. The cervical os was dialated up to a #6 Hegar dilator that was left in place allowing mobilization of the uterus.

A 0.5% bupivicaine solution was used to infiltrate in the subumbilical area as well as the suprapubic area for a total of 7 cc. A 10 mm subumbilical incision was made through the skin with a #11 blade. The Veress needle was inserted into the peritoneal cavity and insufflation revealed an opening pressure of < 6 mmHg. The peritoneal cavity was insufflated with CO2 gas to a maximum pressure of 15 mmHg. The Veress needle was removed and a 10 mm trocar was introduced without difficulty into the peritoneal cavity through this site . The 10 mm laparoscope was then introduced and visualize confirmation of peritoneal entry was made. The uterus was visualized and was noted to be normal. The tubes and ovaries were also normal in appearance bilaterally. The upper abdomen was visualized and a normal liver, gallbladder and diaphragm were seen. No signs of hemorrhage were noted from entry with the trochar.

A 5 mm suprapubic incision was then made through the skin and a second 5 mm trocar was introduced in the peritoneal cavity under direct visualization. The Filshie clip was introduced through this port and the tubes including the fimbriated ends were visualized bilaterally. These were clipped with the Filshie clips 2 cm from the cornua on both sides without difficulty, ensuring blanching could be visualized prior to clip release. Careful examination with the laparoscope ensured that the clips traversed the entire tube. The Filshie clip applicator was removed and the suprapubic port was removed under direct visualization. The amdomen was then reassessed again to ensure hemostasis was appropriate. The CO2 gas was allowed to escape and the subumbilical port was removed with the laparoscope in place allowing visualization of any bleeding. None was noted.

The skin incisions were approximated with 3-0 vicryl sutures in a subcuticular manner. Hemostasis was again found to be adequate. The Hegar dilator was removed from the uterus and the tinaculum was removed from the cervix while assessing for any tinaculum site bleeding. None was noted. All sponges, instrumments, and sharps were counted and found to be correct at the end of the procedure. Estimated blood loss was 20 ml. The patient tolerated the procedure well and was transported to the recovery room in stable condition.