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Operating Theatre Report

April 13th April 15th 2015


Consultants
dr. Indang, OBGYN (C)
dr. Noviady OBGYN
dr. Sita, OBGYN
dr. Rizka, OBGYN
dr. 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

Procedure

N
o

Case

Ms. D, 45 yo, P3
MR: 26.16.67

Triawa
Dilatation
and
Curettage

dr. Rizka,
OBGYN/ Agrifa
(T2A/level II)
ICD 10
N93.9
ICD-9CM
69.1

CC : Vaginal bleeding
since 15 days Before
Admission
Pre op diagnosis:
AUB due to susp
Hyperplasia
endometrium
Post op diagnosis:
Susp Hyperplasia
endometrium

Outcome
Under TIVA
Performed curettage of endocervix

came out 5 cc tissues PA


Performed curettage of
endometrium came out 5 cc
tissues PA
Bleeding was minimal
Now patient is in good condition,
already discharged

Procedure

N
o

Case

Ms. L, 40 yo, P2
MR: 80.35.95

Triawa
Subtotal
Hysterectom
y, right
oophorectom
y
dr. Noviady,
OBGYN/
Thomas
(T3A/level II)
ICD 10
D25.1
D27
ICD-9CM
68.39
65.39

CC : abdominal pain
since 3 months prior
admission
Pre op diagnosis:
Multiple uterine fibroid
Post op diagnosis:
Multiple uterine fibroid
right solid ovarian
neoplasm

Outcome
Under spinal anasthesia
Pfannenstiel incision
When 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 mass
Decided to be performed
hysterectomy
Both round ligament was clamped,
cut and sutured
Vesicouterine fold was incised and
bladder pushed downward
Both tubes and ovary suspensory
ligaments were clamped, cut and
sutured
Uterine vessels were clamped, cut
and sutured
On further exploration, found
cervix was elongated and posterior
isthmus part adhered to rectum
Decided to be performed subtotal
hysterectomy
Uterus was cut as high as isthmus
cervical stump was sutured

Procedure

N
o

Case

Ms. L, 40 yo, P2
MR: 80.35.95

Triawa
Subtotal
Hysterectom
y, right
oophorectom
y
dr. Noviady,
OBGYN/
Thomas
(T3A/level II)
ICD 10
D25.1
D27
ICD-9CM
68.39
65.39

Outcome

CC : abdominal pain
since 3 months prior
admission

Continued the procedure of right


oophorectomy
Right infudibulopelvic ligament was
clamped cut and sutured
Ensured no bleeding
Abdominal wall was closed layer by
layer

Pre op diagnosis:
Multiple uterine fibroid

Bleeding was 300 cc, urine output


250 cc

Post op diagnosis:
Multiple uterine fibroid
right solid ovarian
neoplasm

Patient is in good condition in the


ward

Procedure

No

Hysterosco
py
Diagnosis,
Laparosco
py
Myomecto
my &
Adhesiolys
is

Triawa

dr. Sita
OBGYN/dr.
Made Desi
OBGYN/Tho
mas
(T3A)
ICD 10
D25.1
N74
N97
ICD 9-CM
65.89
68.29

Case

Mrs. Y, 33 yo, P0
MR 80.28.38
CC: Abdominal Pain
since 3 month BA
Pre op diagnosis:
Salphyngitis
Post op diagnosis:
Internal genitalia
adhesion,
Subserous Uterine
fibroid
Non patent right tube

Outcome
Under General anesthesia
On hysteroscopic view, found
uterine cavity with endometrium
on late proliferative phase,
found bubble on left ishtmus and
no bubble on right isthmus ~
right tubal obstruction
On laparoscopic view, found
uterus ???, however posterior
corpus was adhere to rectum,
theres also complex mass from
right tube and right ovary, as well
as complex mass from left tube
and left ovary
Performed adhesiolysis
Performed chromatubation,
patent left tube, non patent right
tube

Procedure

No

Triawa
Miomecto
my,
Adhesiolys
is
dr. Sita
OBGYN/dr.
Made desi
OBGYN/Tho
mas
(T3A)
ICD 10
D25.1
N74
N97
ICD 9-CM
65.89
68.29

Case

Mrs. Y, 33 yo, P0
MR 80.28.38
CC: Abdominal Pain
since 3 month BA
Pre op diagnosis:
Salphyngitis
Post op diagnosis:
Internal genitalia
adhesion,
Subserous Uterine
fibroid
Non patent right tube
month BA
Pre op diagnosis:
Salphingitis

Outcome
On further exploration, found
subserous uterine fibroid on
anterior corpus diameter 2 cm
myomectomy
Ensure no bleeding
Abdomen washed with
aquabidest 500 cc
The mass was taken out with
endobag
Trochars was released
Trochar wound was sutured with
PGA no 2-0
Bleeding 10 cc, urine output 300
cc
Patient is in good condition,
already discharged

Procedure

No

Laparotomi
Frozen
Section
continued
with
conservativ
e surgical
staging,
Myomectom
y,
Adhesiolysis

Triawa

dr. T. Indang
Dewi/ dr.
Henny,
OBGYN/Cynthi
a
(T3A) level II
ICD 10
C56
D25.1
ICD 9-CM
65.51
68.29

Case
Mrs. S, 39 yo, P2
MR 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 cyst
Multiple Uterine fibroid

Outcome
Under general anesthesia
Mediana incision along the old scar until 2
finger above umbilicus
When 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 ovary
On further exploration, did not fine left
ovary, on right ovary seen cystic mass
5 cm performed adhesiolysis cyst
ruptured, came out chocolate fluid sent
to VC
VC resuls cystadeno serous
papiliferous, no sign of malignancy
Procedure then continued with total
hysterectomy
omentectomy, 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