OPERATION REPORT OF OBSGYN DEPARTMENT

DATE OF OPERATION: 28th December 2015 (12.15-15.15, duration 3 hours)

EXCISED TISSUES : Uterus, right and left fallopian tubes, right and left ovarium,
omentum, (????)

PREOPERATIVE DIAGNOSES:
Ovarian cyst susp malignancy

POSTOPERATIVE DIAGNOSES:
Susp. Ovarian cancer stage III C (waiting for Pathology Anatomy definitive result)

OPERATIONS/PROCEDURES PERFORMED:
1. Supracervical hysterectom
2. Bilateral salpingo-oophorectomy
3. Omentectomy
4. Right pelvic lymphedenectomy
5. Adhesiolysis

SURGEON: dr. Ardhanu SpOG (K)

ASSISTANT: dr. Dina, dr. Yoshi

ANESTHESIA: regional anesthesia.

ANESTHESIOLOGIST: dr. Yusmein, Sp. An (K)

ESTIMATED BLOOD LOSS: 900 cc

DRAINS: None.

PROPHYLACTIC ANTIBIOTICS : Cefotaxime 1 gr.

COMPLICATIONS: None.

OPERATION REPORT;

Operation precedure was begun. On the anasthesia stage, midline incision was
performed. Incision was deepen layer by layer until reached parietal peritoneum.
Peritoneum was opened and performed exploration. 100 ml of serous ascites liquid was
taken for cytology examination. Cyst mass on the right ovarian was visualized with size
of 30x25x25 cm, adhered tightly to the pelvic wall, part of the colon, omentum and liver.
Left ovarian cyst with size of 20x15x15 cm adhered tightly to the pelvic wall, part of
colon and omentum. Uterus was enlarged and noduled with size of 20x15x10 cm. The
adhesion was attempted to be freed. The right cyst was perforated and it spilled
brownish serous liquid +- 12.5 L. The left cyst was perforated and it spilled brownish
serous liquid +- 4 L/

Right and left round ligament were K/G/J (iki opo yo?). Plica VU was opened and
incised caudally then lateral peritoneum was opened. Exploration was performed on the
retroperitoneal, right and left ureter were within normal limit. Right and left ligamentum
infundibulum pelvicum together with right and left ovarian arteries were K/G/J. There
were great adhesions of the posterior wall of the uterus with rectosigmoid. Cavum
Douglasi could not be identified.
It was decided to perform excision on the supra cervical by ligating right an left uterine
arteries. (??????) of the cervix was sutured with continuous stitch. Hemostasis was
achieved, no bleeding, and then performed omentectomy. Right illiaca lymph node was
looked enlarged +- 1x??? And then performed lymphadenectomy illiaca dextra.
Hemostasis was achieved, no bleeding.
Abdominal wall was sutured layer by layer. The skin was sutured intracutaneously.

OPERATION REPORT OF SURGERY DEPARTMENT

DATE OF OPERATION: 28th December 2015 (13.30-14.15, duration 45 minutes)

PREOPERATIVE DIAGNOSES:
Cystoma ovarii susp malignancy

POSTOPERATIVE DIAGNOSES:
Cystoma ovarii susp malignancy
Adhesions of cystoma ovarii grade II-III to the liver, peritonium and sigmoid colon

OPERATIONS/PROCEDURES PERFORMED:
Adhesiolysis

SURGEON: dr. Imam Sofii, SpB, KBD

ASSISTANT: dr. Kamal, dr. Kris, dr. Riza

ANESTHESIA: General anesthesia.

ANESTHESIOLOGIST: dr. Yusmein, Sp. An

ESTIMATED BLOOD LOSS: 900 cc

OPERATION REPORT;

1. Received consultation from Obgyn department during the operation

2. Continued the operation
3. Exploration of the right cyst-sac cranially found adhesion of the cyst with hepatic bed,
peritoneum and omentum. Adhesion grade III was freed bluntly, the cyst-sac could be
(????)
4. Exploration of the right and left cyst-sac on the caudal part, adhesions grade IV to the
sigmoid colon were freed sharply. There was 2 cm laceration of the sigmoid serous which
was sutured with vicryl 3/0
5. Hemostasis was achieved
6. Put on sponges on the hepatic bed
7. Operation was continued by colleague from Obgyn department

PA result 1
Cytology sample showed spread of inflammatory cells dominated by lymphocytes and enough
macrophage. The mesothelium cells were also enough. On the other part, there were grouped
epithelial cells, monomorf cells with scanty cytoplasm, round, oval, and fine chromatin.

The background was amorf mass and the erytrhocytes were spread.

Malignant cells were not found.

Conclusion

Cytology of ascites liquid : there were not found malignant cells

Opinion : supports the external endometriosis diagnosis

PA result 2

3 pots of tissues according to the identity

1. Uterus, right and left ovarian

A uterus tissue with two adnexes, without cervix, corpus with the size of 12x10x9 cm, on the
excision had not been fixed. It was fixated first.
On the excision after fixated, from the stem of the cervix, printed 1 (KUPE???)
From the excision of the corpus, it was found multiple white masses, clearly demarcated,
diameter 0.5-9 cm, circular, endometrium with thickness 0.1 cm, myometrium with
thickness 1-7.5 cm, white coloured with black patches. Masses from endometrium,
myometrium were printed 2 KUPE??
From one of the adnex (without the thread label), ovarian with the size 4x8x8 cm, in the
form of pouch was already opened, the outer part was shiny, the inner part was coarse.
There was no mass and papillary growth, the wall thickness was 0.3-0.7 cm, white-brownish
in color, elastic, were printed 3 KUPE (C). The tube was adhered, 10 cm long, diameter 0.5
cm, white brownish in color, elastic, was printed 3 kupe (D).
From the other adnex without thread label, ovarian was in the form of pouch that was
already opened, 21x15x15 in size, the outer surface was whit brownish, shiny, and inner
surface was coarse, filled with remaining brown yellowish mass. There was no papillary
growth, wall thickness was 0.3 cm, elastic, were printed 4 kupe (E). The tube was adhered,
10 c long, diameter 0.5 cm, white brownish, elastic, was printed 3 kupe (F)
2. Omentum
A tissue in the form of sheet, 7-23x0.3-8.5 cm in size, with thickness of 0.2-0.5 cm, yellow
brownish in color, elastic, on the investigation there was no thickening, was printed 3 kupe
(G)
3. Right Lymph node
A tissue in the size of 2x0.5x0.4 cm, white in color and yellow in some part, everything was
printed and splitted (H)

Microscopic

The preparation shoed

 A. Endometrial tissue with endometrial gland and there was found mesenchymal tumor
that arranged as longitudinal and transverse bundles. Monomorf cells, spindle shaped,
abundant cytoplasm, eosinophilic. The nucleus was round, oval, fusiform with both end
were blunt, fine chromatin, stroma with enough hyalinisation.
B. Endometrial tissue with endometrial gland closely enough. In general the shape was
tubular, with some cystic dilatation filled with eosinophilic mass. Myometrium with
mesenchymal tumor as seen on A.
C. Ovarian tissue with cyst, bordered with granulation tissue and connective tissue,
inflitrated with enough hemosiderophage
D. Tube tissue on the tube wall was also found endometrial gland woth the stroma.
E. Ovarian cyst tissue as seen on C
F. Tube tissue as seen on D
G. Adipose and connective tissue, and blood vessel with endometrial nests
H. Lymphnode tissue with dilatation of the sinus, inflitrated with lymphocytes and enough
hystiocytes. There was no found malignancy sign.

Conclusion

Uterus : leiyomyoma sub mucosa and intramural

Simple- non atipic hyperplasia of endometrial gland

One of the adnex : ovarian : cyst : bleeding in accordance with external endometriosis

Tube : chronic salphyngitis with external endometriosis

Another adnex : ovarian : external endometriosis

Tube : chronic salphyngitis with external endometriosis