garlam2029
Guest
I have a provider who performed a Laparoscopic Salpingectomy for sterilization and then he aspirated a cyst on the L ovary.
The fallopian tubes appeared to be normal on both right and left sides. The fimbriated end however of the patient's right fallopian tube was incorporated into the posterior peritoneum on the patient's right side. The cul-de-sac was free. There was no evidence of endometriosis. The ovary on patient's right side was normal however the left side contained 3 small cysts. The largest of the cyst was approximately 2-1/2-3 cm. Using a needle aspirator and 10 mL syringe each one of the ovarian cysts would be entered with the needle aspirator and then the individual cysts would be aspirated into the 10 mL syringe and specimens would be sent for cytology. This decompressed the entire left ovary. The patient's bleeding and hemostasis on the left ovary was normal. At this point the ureters were visualized on both right and left sides. The pelvic vessels were identified. The patient had the fimbriated end of the fallopian tube on the right tented medially and coming underneath the fallopian tube and above the peritoneum I was able to lyse adhesions with a curved Metzenbaum laparoscopic scissor.
Once this was done this freed the fimbriated end and I was able to now use the LigaSure to come across the tissue between the ovary and the fallopian tube. Electrocoagulation ×3 and then transection would be done across the entire mesosalpinx to the cornu of the uterus on the right side. The fallopian tube within the crossclamped and electrocoagulated and then transected. This freed the entire tube. The tube was brought up through the right port site. The same procedure was carried out on the contralateral side except without the adhesions.
Specimens would be labeled as right and left fallopian tubes.Once this was done this freed the fimbriated end and I was able to now use the LigaSure to come across the tissue between the ovary and the fallopian tube. Electrocoagulation ×3 and then transection would be done across the entire mesosalpinx to the cornu of the uterus on the right side. The fallopian tube within the crossclamped and electrocoagulated and then transected. This freed the entire tube. The tube was brought up through the right port site. The same procedure was carried out on the contralateral side except without the adhesions.