Operating Theatre ReportApril 13th – April 15th 2015

Consultants

dr. Indang, OBGYN (C)dr. Noviady OBGYN

dr. Sita, OBGYN dr. Rizka, OBGYNdr. Henny, OBGYN

RSGS Team April 2015

Reporting• 1 Dilatation and curettage

• 1 Laparotomy subtotal hysterectomy, right oophorectomy• 1 Hysteroscopy Diagostic and Laparoscopy myomectomy &

adhesiolysis

• 1 Laparotomy Frozen Section continued with Total hysterectomy, Right salphyngo-Oophorectomy, Omentectomy, Bilateral Pelvic Lymphadenectomy, adhesiolysis

TriawaProcedure No Case Outcome

Dilatation and Curettage

dr. Rizka, OBGYN/ Agrifa(T2A/level II)

ICD 10N93.9

ICD-9CM69.1

1 Ms. D, 45 yo, P3MR: 26.16.67

CC : Vaginal bleeding since 15 days Before Admission

Pre op diagnosis:AUB due to susp Hyperplasia endometrium

Post op diagnosis: Susp Hyperplasia endometrium

Under TIVA Performed curettage of endocervix came out 5 cc tissues PAPerformed curettage of endometrium came out 5 cc tissues PABleeding was minimal

Now patient is in good condition, already discharged

TriawaProcedure No Case Outcome

Subtotal Hysterectomy, right oophorectomy

dr. Noviady, OBGYN/ Thomas(T3A/level II)

ICD 10D25.1D27

ICD-9CM68.3965.39

1 Ms. L, 40 yo, P2MR: 80.35.95

CC : abdominal pain since 3 months prior admission

Pre op diagnosis:Multiple uterine fibroid

Post op diagnosis: Multiple uterine fibroidright solid ovarian neoplasm

Under spinal anasthesiaPfannenstiel incisionWhen peritoneum was open, seen uterus enlarged with multiple fibroid from diameter 1 cm – 5cm, both tube, left ovary within normal limit, right ovary seen solid massDecided to be performed hysterectomyBoth round ligament was clamped, cut and sutured Vesicouterine fold was incised and bladder pushed downwardBoth tubes and ovary suspensory ligaments were clamped, cut and suturedUterine vessels were clamped, cut and suturedOn further exploration, found cervix was elongated and posterior isthmus part adhered to rectumDecided to be performed subtotal hysterectomyUterus was cut as high as isthmuscervical stump was sutured continously with PGA no.1

TriawaProcedure No Case Outcome

Subtotal Hysterectomy, right oophorectomy

dr. Noviady, OBGYN/ Thomas(T3A/level II)

ICD 10D25.1D27

ICD-9CM68.3965.39

1 Ms. L, 40 yo, P2MR: 80.35.95

CC : abdominal pain since 3 months prior admission

Pre op diagnosis:Multiple uterine fibroid

Post op diagnosis: Multiple uterine fibroidright solid ovarian neoplasm

Continued the procedure of right oophorectomyRight infudibulopelvic ligament was clamped cut and suturedEnsured no bleeding Abdominal wall was closed layer by layer

Bleeding was 300 cc, urine output 250 cc

Patient is in good condition in the ward

TriawaProcedure No Case Outcome

Hysteroscopy Diagnosis, LaparoscopyMyomectomy &Adhesiolysis

dr. Sita OBGYN/dr. Made Desi OBGYN/Thomas(T3A)

ICD 10D25.1N74N97

ICD 9-CM65.8968.29

1 Mrs. Y, 33 yo, P0MR 80.28.38

CC: Abdominal Pain since 3 month BA

Pre op diagnosis:Salphyngitis

Post op diagnosis: Internal genitalia adhesion, Subserous Uterine fibroidNon patent right tube

Under General anesthesiaOn hysteroscopic view, found uterine cavity with endometrium on late proliferative phase,found bubble on left ishtmus and no bubble on right isthmus ~ right tubal obstructionOn laparoscopic view, found uterus ???, however posterior corpus was adhere to rectum, there’s also complex mass from right tube and right ovary, as well as complex mass from left tube and left ovaryPerformed adhesiolysisPerformed chromatubation, patent left tube, non patent right tube

TriawaProcedure No Case Outcome

Miomectomy,Adhesiolysis

dr. Sita OBGYN/dr. Made desi OBGYN/Thomas(T3A)

ICD 10D25.1N74N97

ICD 9-CM65.8968.29

1 Mrs. Y, 33 yo, P0MR 80.28.38

CC: Abdominal Pain since 3 month BA

Pre op diagnosis:Salphyngitis

Post op diagnosis: Internal genitalia adhesion, Subserous Uterine fibroidNon patent right tubemonth BA

Pre op diagnosis:Salphingitis

On further exploration, found subserous uterine fibroid on anterior corpus diameter 2 cm myomectomyEnsure no bleedingAbdomen washed with aquabidest 500 ccThe mass was taken out with endobagTrochars was releasedTrochar wound was sutured with PGA no 2-0

Bleeding 10 cc, urine output 300 cc

Patient is in good condition, already discharged

TriawaProcedure No Case Outcome

Laparotomi Frozen Section continued with conservative surgical staging, Myomectomy, Adhesiolysis

dr. T. Indang Dewi/ dr. Henny, OBGYN/Cynthia(T3A) – level II

ICD 10C56D25.1

ICD 9-CM65.5168.29

1 Mrs. S, 39 yo, P2MR 80.24.59

CC: Have another ovarian mass on the right side

Pre op diagnosis:Cystic ovarian neoplasm history of incomplete surgical staging (borderline ovarian tumor)

Post op diagnostic: Benign Ovarian cystMultiple Uterine fibroid

Under general anesthesiaMediana incision along the old scar until 2 finger above umbilicusWhen peritoneum was open seen slightly enlarged uterus with lobulated mass within the uterus ~ uterine fibroid; Seen adhesion between uterus and bowel as well as right ovaryOn further exploration, did not fine left ovary, on right ovary seen cystic mass θ 5 cm performed adhesiolysis cyst ruptured, came out chocolate fluid sent to VCVC resuls cystadeno serous papiliferous, no sign of malignancyProcedure then continued with total hysterectomyomentectomy, and bilateral pelvic lymphadenectomy

Bleeding intra operative 250 cc, Urine 200 cc clear

Patient is in a good conditioin the ward, plan to be discharged

THANK YOU