Polyclinic staff examination USG: Vesicaurinaria : showna prolap mass (ga kebaca) intrra papil (+) > 25 cm Right

kidney: (blabla) grade I Left kidney: normal Liver: No metastasis Lymph node (blabla) hard to evaluate Minimal ascites

RVT (maaf ga ebaca semua, gatau..T.T) Dx : Clinical impression Ca Ovarii advance stage Tx: Neo Advance Chemotherapy (CAP) 3 series Just undergo surgery Hospitalization check routine blood

_________________________ Patients name:Romlah,Mrs Date of birth/gender: 27/05/1967 F MR number : 01191562 Specialist: Obsgyn (dr.Teguh,SpOG) Assistant: Amir N,Dr. fathoni Nurse: ? Anesthesiologist name/assistant: dr. Husni,Sp.An/sugeng Pre-operative diagnose: ca cervix IB1 Post-oprative diagnose: ca cervixIB1

Excision/ incision tissue(s): radical hysterevtomy, bilateral salphyngopharectomy,, pelvic lymphadenectomy dextra et sinistra Sent from examnation: PA : Yes Operation date: 16/05/2013 Time start: 08.00 Time end: 13.39 Reguler: Kind of operation:major surgery

Findings/ Operation report: (Add more paper if necessary) -patient supine above the operating table under general anesthesia -Aseptics and antiseptics, including vaginal toilet -attaching rectal tube -maylard incision -exploration after peritoneum is open:siz of uterus normal and mobile, cervix mass solid-supple, size:5x4x4cm,mobile, weak parametrium, Ovary and tuba dextra et sinistra arenormal on siza and shape Exploration on Gastrointestinal track: pelvic and abdomen peritoneum wall, liver and lien surface, gaster, and omentumare normal -Decide to perform Radical hysterectomy and bilateral salphyngopharectomy,and right and left pelvic lymphadenopathy -attaching uterus traction via osner clamp -on the right side,rotundum ligament is tied and cut.anterior broadly incised to medial toward plica vesicoenterika. Posterior broadly invundibulopelvicum ligament is being prepared and tied, then cut - do the same thing on the left side. Move aside vesica urinaria sharply and bluntly to posterocaudal ___________________________________

- oN the right side ,by sharp and blunt dissection (ga kebaca)paravesica, developed parametrial recognized -Perform pelvic lymphadenopathy -Openperitoneum through vasa iliaca communis,move ureter aside to medial by retractor (foley catheter) so vasa iliaca communis could be seen. Lymph node lateral border is waived the exact medial from Nevus genitofemoralis -Iliaca communis lymph node is pared from a. iliaca communis as high as bifurcation aorta. Then the most lateral a. iliaca lymph node pared toward canalis inguinalis.until v.circumplexa as the distal border.KGB is pared from thisborder to proximal. -Lymph nodes which adjacent tom.psoas s freed to dorsalto reach obturator space. Lymoh nodes which along m. obturator is freed to (ga kebaca). Lymph nodes is clamped by peniler andbeing freed from medial wall (Vesica wall,parametrium,cardinal ligament), -v. iliaca, a.iliaca internaamd ligamentum umbilicalis lateral is recognized.then (ga kebaca) is ligated and cut to proximal as close to a.hipogastrica branching. Perform preparation of paramethrium .( gakebaca). Paramethriumis cut and tied.Ureter is freed from a.urinariathen freed from the tunnel sharp and blunty.vesica urinaria posterior and anterior ligamentum (baledr pillar) is identified,then cut and tied. ureter is freed from the tunnel to its insertion in vesica. - do the same procedure on the left side -(ga kebaca) of uterus is being slashed as high as intrauterine to separate posterior part of uterine with (ga kebaca). Ligamentum(ga kebaca) is recognized,then perform preparation and preservation ofnervus hypogastricusinferior. Ligamentum sakrouterina is clamped and cut gradually to dorsal,so the back side of proximal vagina is freed.vesica ismoved down to dorsal until anterior vagina is freed. Pervaginam tissues are clamped, tied and cut so the lateral part of anterior vagina is freed. Perform beheading as high as 1/3proximal vagina.the top vagina is stich together.. - (ga kebaca) abdomen is washed by NaCl 0,9%,after no bleeding statement, kassa could be removed - abdomen wall closed by (ga kebca) closure (all-layer) -attached suprapubic catheter Operation finished Bleeding During operation: 500cc Urine production during operation: 250cc Operation complication: negative

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Name/gender: Sudarmi/F MR number: 00756634 1/4/13 Midwifery S; patient come with a mass on stomach, itchy leucorrhea, bigger stomach B: Compos mentis, General state; good appearance Blood pressure: 140/90 Pulse :78/minute

A: Endometrosis R: control /4/13Obsgyn P2A0, 57 years old A femal P2A0, 57 years old come based on referralfrom pajang public health service with a mass on abdomen. Patient felt the mass since a year ago. A weight loss also felt since a years ago.abdominal obstruction (+), urrinay disorder (-),defecation disorder (-) Past medical history: Hypertension/ Diabetes mellitus/ heart disease/ allergy denied General state:good,compos mentis Blood pressure : 140/90 Pulse RR Temperature : 70x/minute : 20x/meinute : febris

Eyes: Anemic Conjunctiva (-/-), Icteric sclera (-/-) Thorax: on normal stage Abdomen: Supple, no tenderness, cystic mass palpable, mobile and superior border as proc.xypoideushigh, right border: Linea axillaris anterior dextra, left border: Linea axillaris anterior sinistra, ascites (-) Genitalia:

Inspection:vesica urinaria looked steady, nomal vaginal wall,normal portio, no bruised/nodule, sonde: 5 cm VT: vesica urinaria looked steady, smooth vaginal wall,no nodules on portio, not mobile when the mass is moved, uterus size as chickenegg. USG: Vesicaurinaria full,uterus can be seen, hipoechoic lesion,septa on adnexa mass. Siza: 25/15/30 cm

Dx: Ovarii cystoma Tx: hospitalization proposal -ca 125 examination+ x-ray photo proposal -Kystectomy+F2 proposal -ward staff examination proposal