EXPLAIN: OVARIAN TUMOR

CONTENT: LAPAROSCOPIC SURGERY ON OVARIAN TUMOR

Clinical Information:

A {{Pre-menopause, Peri-menopause with HRT treatment, Menopaused without HRT treatment, Menopaused with HRT treatment}} patient,

Major symptoms and signs:

Abnormal uterine bleeding: [[Irregular bleeding, Menorrhagia, Hypomenorrhea, Persistent spotting]]

Pain: [[Dysmenorrhea and, Chronic, Persistent, Cramping, Dull ]][[LLQ pain, RLQ pain, mid-lower abdominal pain, diffuse abdominal pain, periumbilical pain, flank soreness, low back pain, with radiation to leg].

{{With, Without}} [[abdominal tenderness, rebound pain, muscle guardness, nausea]]

Severity of pain: [[analgesics in vain, interrupt her daily work, ever been sent to ER for analgesics, analgesics not needed, analgesics needed and effective]]

Mass effect: [[Nil, Palpable abdominal mass, Frequency, Tenesmus, Bearing down sensation]]

Sonography:

Uterus: {{There are/is _____ myomata measuring up to _____ cm, Adenomyosis measuring up to ______cm.}}

Right adnexa: {{Normal size, mass measuring up to ____ cm}}

Left adnexa: {{Normal size, mass measuring up to ____ cm]]

Pap smear: {{Nil, TBS number _____}}

Fr D&C + CxBx: {{Nil, Benign, with malignant change _____________________}}

CA-125: __________

Operative Procedures:

Type of operation: LAPAROSCOPIC SURGERY: [[BSO, RSO, LSO, RO, LO, BS, RS, LS, Enucleation of ovarian tumor, Wedge resection of ovary, Enterolysis, Appendectomy]] + Lysis of adhesion,

The patient was placed in the dorsal lithotomy position with both legs wrapped with elastic bandage. The uterine manipulator was inserted through the cervix and locked in place. The patient was placed in the Trendelenberg position, the telescope was introduced through the umbilicus after establishing a pneumoperitoneum of 15 mmHg in pressure with Veress needle. And two other 5-mm accessory cannulas were placed through each lower quadrant. The adhesion tissues were removed, and the intestine, the omentum, and the peritoneum were separated and relocated at sites as normal anatomical structures.

If the total adnexectomy was to been performed, firstly the infundibulopelvic ligament was secured, coagulated, and cut. And step by step the tissue of the Fallopian tube and the mesosalpinx were secured, coagulated, and cut. After the ovarian ligament was cut, the adnexa was totally removed.

If the enucleation was to be performed, an elliptical incision was made over the wall of the ovarian tumor through the cortex. A plane is developed and the tumor was mobilized by sharp and blunt dissection. Once the tumor is removed, the inner ovarian stroma was coagulated with the bipolar electrocautery to achieve satisfactory hemostasis and approximation. The cortex may be closed with several separated sutures of 3-0 vicryl if needed.

The specimen was then put into a sterile plastic bag and later removed within the bag. The whole pelvis and operation sites were irrigated thoroughly and under-water examination was performed to ensure the proper hemostasis. The procedures ended with careful removal of the instruments and closure of the wounds. The patient stood the procedure well.

Operative Finding:

Ovarian tumor {{with, without}} [[torsion, ruptured, ascites, bleeding, adjacent adhesion]], Lining [[smooth, with papillary neogrowth]],

Uterus: {{AVF, RVF}}, {{Normal size, enlarged as GA ____ weeks size}}.

Right ovary: [[free, adhesion]] and [[grossly normal, solid mass measuring up to __ cm, cystic mass measuring up to __ cm, mass with mix component measuring up to __ cm]]

Left ovary: [[free, adhesion]] and [[grossly normal, solid mass measuring up to __ cm, cystic mass measuring up to __ cm, mass with mix component measuring up to __ cm]]

Right tubes: [[free, adhesion]] and [[grossly normal, s/p ATS, hydorsalpinx, __________]]

Left tubes: [[free, adhesion]] and [[grossly normal, s/p ATS, hydorsalpinx, __________]]

Cul-de-sac: [[free, ascites, membranous adhesion, partially obliterated, total obliteration, _____________]]

Adhesion: among/between [[uterus, left adnexa, right adnexa, colon, small intestine, pelvic side wall]]

Complication: [[Massive bleeding, Bladder injury, Ureter injury, Bowel injury, __________________ ]]

Pathology:

Dr:_______________________ Date:______________________