The following is a copy of my operative report from my endometriosis surgery in 1986. This surgery diagnosed my endo and it was determined to be stage 4/severe. I have also included one of the pathology reports. It is always good (important!) to request a copy of these reports for your own records. Not only can it help you to understand what took place during the surgery, but you will then also have them for future reference if your doctor moves, retires, you change doctors, etc.
Abdominal saline lavage to lab for cytology at 1300. Right adnexal etiology.
PREOPERATIVE DIAGNOSIS: Pelvic pain – Right ovarian mass
POSTOPERATIVE DIAGNOSIS: Pelvic endometriosis with right adnexal
OPERATION: Laparoscopic examination – Exploratory Laparotomy
OPERATIVE FINDINGS AND TECHNIQUE IN DETAIL: Right oopherectomy and salpingectomy. Weighed blood loss 350 cc.
PROCEDURE: Examination under anesthesia and diagnostic laparoscopy, pelvic laparotomy, right salpingo-oopherectomy, right para-ovarian peritoneal cystectomy.
HISTORY: Patient is a 32-year-old para 2, -0-0-2, LMP 10-9-86, using a vasectomy for contraception who was seen with a 2 month history of recurrent right sided low abdominal pain of uncertain etiology. On examination her uterus was noted to be retroflexed, semi-mobile, parous sized, with right adnexal fullness and tenderness. An ultrasound was obtained which confirmed the fullness on the right adnexal region which showed 7.9x5.7cm. oblong cystic mass involving the right adnexa. The significance of an adnexal mass and the necessity for exploration was reviewed with the patient at length on 10-24-86. The patient subsequently returned to see Dr. _ on 10-25-86 at which time exploration was scheduled. Her preoperative history, past medical history, physical examination, laboratory parameters showed no contraindications to surgery or anesthesia.
DESCRIPTION OF THE SURGERY: Under general anesthesia with the patient in the lithotomy position, examination under anesthesia showed a mass involving the cul-de-sac posteriorily, somewhat more deviated to the left side then was initially appreciated at the time of the examination in the clinic.
After prep and drape in the usual manner for laparoscopy the bladder was catheterized with Foley catheter which was left in place. A weighted speculum was placed in the vagina and the cervix was grasped with a tenaculum and the laparoscopic cannula was inserted into the cervix. Attention was directed to the abdominal field where a subumbilical stab incision was made and extended for approximately 1 cm. Veres needle was inserted into the peritoneal cavity which was insufflated with two liters of CO2 gas, creating a pneumoperitoneum. Laparoscopic trochar was inserted into the abdomen, bluish cystic mass or a portion of one could barely be detected in the cul-de-sac. Probing trocar was inserted through a separate stab incision in the pubic hairline in the midline and exploration of the pelvis showed peritoneal cysts involving the cul-de-sac, posterior aspect of the uterus which was difficult to move despite the cannula and tenaculum. Signs suggestive of endometriosis were noted. Incisions were closed with subcutaneous figure X sutures of 4-0 Vicryl.
The patient was re-prepped and draped in the supine position. A vertical incision was made between the symphysis and umbilicus. Bleeders were coagulated as they were encountered. Fascia was incised and divided the length of the incision. Rectus muscle was sharply and bluntly dissected from the right fascia edge. The peritoneal cavity was entered through the posterior rectus sheath. Exploration of the pelvis and the abdomen followed saline irrigation and aspiration for peritoneal fluid cytology. Multiple peritoneal cysts as well as enlarged cystic right ovary adherent to the posterior aspect of the uterus and right broad ligament for the entire length of the uterus was noted. Colonic adhesions to the left adnexal region were also noted. The left tube and ovary was otherwise normal in appearance with some slight tenting of the peritoneum about the left fallopian tube. The bowel contents were inspected and the appendix was in inferior position, normal in texture and appearance. The upper quadrants were free of adhesions bilaterally with a palpably smooth liver. The gallbladder was visualized and palpably normal and fee of stones. The kidneys were palpably normal and the spleen was palpably normal. The stomach was inspected and was normal. The omentum was free of adhesions or tumor implants.
Self-retaining retractor was placed and the bowel contents were packed from the operative field. The retroperitoneal space was entered superior to the right round ligament and dissected down over the psoas muscle exposing the right external and common iliac vessels. The right infundibulopelvic ligament was isolated, doubly ligated on its proximal pedicle with 2-0 Surgilon and ligated on the distal pedicle and with the ureter in full view the infundibulopelvic ligament was divided. The retroperitoneal dissection was carried from the posterior aspect of the uterus and the posterior aspect of the right broad ligaments. Several peritoneal cysts ruptured on dissection and ultimately the right ovarian cyst ruptured with a large amount of chocolate fluid consistent with a right endometriosis cyst. With the ureter in full view a right salpingo-oopherectomy was performed. A large right sided peritoneal cyst was sharply and bluntly removed form the posterior aspect of the uterus and the medial aspect of the ovarian cyst. This was submitted separately. The right salpingo-oopherectomy was done with sequential clamps and suture ligatures of #1 chromic. The raw peritoneal surface on the posterior aspect of the right broad ligament was treated with thrombostats to achieve additional hemostasis. The peritoneum was reapproximated with running 2-0. The ureter had been visually inspected throughout the procedure and the retroperitoneal space was thoroughly irrigated prior to closure. With hemostasis present and sponge and needle counts correct and the omentum interspersed between the incision and the pelvis the peritoneum was closed with running 0 chromic. Subfascia and subcutaneous space was irrigated with antibiotic irrigant and fascia was closed with running lock 0 Vicrly started at the apices and tied I the midline. Subcutaneous space was reapproximated with running 3-0 Chromic and the skin was closed with staples. Estimated blood loss was 300 cc. The patient tolerated the procedure and was transferred to recovery in stable condition.
endometriosis cyst, ovarian, and right pelvic peritoneal cysts.