052816

No. MR SURGERY REPORT

Name : Mrs. Sari GumilangSex : FemaleAge : 27 Years

Operator Prof. dr. H. I. O. Marsis, SpOG Anesthetic Dr. Widodo, SpAn

Asistant 1dr. Reza MarsisInstrumentatorZr. Ida Tupa

Asistant 2Ramot Arif BanamtuanObserverAnggun Valensia Manja

Pre-surgical Diagnose : Ectopic Pregnancy

Post-surgical Diagnose : Tubal Ectopic PregnancySurgery Date : November 23rd 2014

Duration time of surgery : 1 hours 30 minutes

Tehnique of operation :Type of surgery

1. Laparoscopy Diagnostic / Laparoscopy Operative Emergency Minor

2. Adhesiolysis Poliklinik Medium

3. Salpingectomy Sinistra Elective Mayor

4. Curettage

5. Hysteroscopy Diagnostic

Operation Procedures:

I. Patient was administrated with general anesthesia in lithotomy positionII. Aseptic and antiseptic were done on abdominal region, external genital region, internal genital, and around.III. Applied sims speculum at posterior vagina continue with sims speculum at anterior vaginaIV. Anterior portio clamped with kohel tang at 12 hour direction. Put off anterior sims speculum.V. Doing sonde uterus to determine the length to the uterus, uterine length 8 cm anteflexion.VI. Doing the curettage of the uterine cavity, clockwise direction starting at 12.00 with curette tang 0 to 3VII. The hysteroscopy diagnostic procedure as followed : 1. Dilated cervical canal with hegar busion number 6,7,and 8.2. Insertion of hysteroscopy to see the endometrial wall and ostium tubae internum dextra et sinistra. Do exploration :

a. The mucosa of cavum uteri is looked pink and normalb. The ostium tubea internum dextra : bubble (+), sinistra : bubble : (-) 3. Conclusion : a. Left fallopian tube is occlutedVIII. Planning : LD/LOIX. Operation procedures of laparoscopy diagnostic/laparoscopy operative followed :1. Patient made in tredelenburg position or the head lower than pelvic area2. Skin on the left and right of umbilicus were clamped using two doek tissue clamped made incision 1 cm below the umbilicus using scalpel3. Abdominal wall was lifted and the Verees needle inserted into umbilical area to intraperitoneal space.4. Pneumoperitoneum procedure or the abdominal cavity is filled with CO2 gas help move abdominal wall and any organs way out, creating a larger space to work.

5. Incision 0,5 cm was made on the right and left ilioinguinal region using scalpel, and then the trocar was inserted into the incision. 6. Laparoscope was inserted into the main trochar and the gasper was inserted into the small trochar.

7. Uterus, pelvic cavity, ovaries, fallopian tubes and the abdominal cavity were inspected (explored) :a. Corpus uteri is looked pink, slippery surface, as big as pears. b. The left ovarian adhesion with the left fallopian tubec. The right ovarian looks white with slippery surface, as big as egg.d. The left fallopian tube looks a mass, as big as egg.e. The right fallopian tube normal.8. Conclusiona. The left ovarian is adhesion to the left fallopian tube.b. Ectopic Pregnancy.9. Planning :

a. Adhesiolysis b. Salphingectomy Sinistrac. Micro curettageX. Operation procedures of laparoscopy operative followed :Adhesiolysis, Salphingectomy sinistra a. Left ovarian was cauterized and separated of the left fallopian tube.b. Resection using laparoscopic scissors to the left ovarianc. The rest of the left ovarian was cauterized to stop bleeding.d. Doing incision in the left fallopian tube to remove the product of conception, and it was ready to send to the pathological anatomye. The bleeding was controlled by using the cauterXI. Abdominal cavity washed by RL solution still in tredelenburg position and suctioning, and it was given hidrocortisone asetat 25 mg/10ml into peritoneal cavity and abdominal cavity was given dextrose.XII. After clean, removed all the trocar, the laparoscope, and the hysterecscope.XIII. Patient in supine position and three holes in cutis was sewed by simple suture with Prolene no.3.0XIV. The operation wound was cleaned with NaCL 0,9% and then it was closed by sufratulle sterill cassa hipafix.XV. Aseptic and antiseptic at external and internal genital regionXVI. The vagina was cleanedXVII. The sample send to pathologist anatomy for the further diagnosticXVIII. The operation finished

The condition of patient postn operation:

General condition : Look mild sick Consciouness

: Compos Mentis Blood pressure

: 110/70 mmHg

Pulse rate

: 98 x/minute

Respiration

: 22 x/minute

Temperature

: 36,7 oC

Tissue to Pathology of Anatomy :

Yes: Date, November 23rd 2014

Type of tissue : product of conseption No Operator,

(Prof. dr. H.I.Oetama Marsis, SpOG)

OBSTETRIC AND GINECOLOGY DEPARTEMENT

BUDHI JAYA MOTHER AND CHILD HOSPITAL

JL. Dr. Sahardjo No. 120 Jakarta Selatan 12960

Telp. (021) 8292672, 8311722, 8312378

Fax. 8301901

PAGE