PREOPERATIVE DIAGNOSIS:
Menorrhagia, possible endometrial polyp.
POSTOPERATIVE DIAGNOSIS: Menorrhagia, possible endometrial polyp.
OPERATION:
1. Diagnostic hysteroscopy using Hyskon solution 1:1.
2. Operative hysteroscopy with polypectomy using 3% sorbitol as distension
medium.
3. Dilation and curettage.
ANESTHESIA:
Laryngeal mask anesthesia (LMA).
CLINICAL INDICATIONS:
ESTIMATED BLOOD LOSS:
Minimal.
IN'S AND OUT'S:
250 cc of Hyskon; saline 1:1 solution used,
total fluid in is 3040 cc, total fluid out is 2490 cc, sorbitol deficit is 450 cc.
FINDINGS:
1. A 1- to 2-cm endometrial polyp attached to the fundus.
2. Abundant polypoid endometrium.
COMPLICATIONS:
None.
PROCEDURE:
The patient was taken to the operating room
where general anesthesia was found to be adequate. She was then placed in a
dorsal lithotomy position using candy-cane stirrups. She was then prepped and
draped in a normal sterile fashion.
A speculum was then placed into her vagina where the anterior lip of the cervix
was grasped with a single-toothed tenaculum. The sound was used to sound the
uterine cavity and found to be about 10 cm. The cervix was dilated serially using
Pratt dilators to a size of 19 and a 5-mm 12-degree diagnostic hysteroscope was
then placed into the endometrial cavity and noted was a 1- to 2-cm endometrial
polyp with a stalk at the anterior fundus. The diagnostic scope was then
removed and the Hyskon solution was stopped. Total Hyskon to saline 1:1
solution 250 cc was used.
Attention was then turned to the operative hysteroscopy portion of the procedure
where the cervix was continued to dilate to a size 31 Pratt dilator. An operative
scope using a size 24 electrical surgical loop, using 3% sorbitol solution as
distension medium was used. The loop was then used to transect the
endometrial polyp at the stalk where it implanted on the fundus. The operative
hysteroscope was then removed and an endometrial curettage was then
performed until the uterus was found to be gritty on all quadrants. The curet was
then removed and the single-toothed tenaculum was then removed and the
cervix was found to be hemostatic. We did use a couple of silver nitrate sticks to
achieve hemostasis on the anterior cervical lip.
The instrument and lap count and sponge count were correct twice and Dr.
Jacoby, our attending physician, was present and scrubbed in throughout the
entire case.
No apparent complications. The patient was moved to PACU in stable condition.
ASSISTANT SURGEON(S):
Alison F. Jacoby, M.D.
Kathleen Yang, M.D.
Ayaba Worjoloh, M.D.
If the assistant surgeon is other than a qualified resident, I certify that the
services were medically necessary and there was no qualified resident available
to perform the services.