SPECIMENS: Pelvic washings, right diaphragm scrapings, left diaphragm scrapings, right paracolic gutter biopsy, left paracolic gutter biopsy, left pelvic sidewall biopsy, right pelvic sidewall biopsy, posterior cul-de-sac nodule, anterior cul-de-sac biopsy, right pelvic lymph nodes and omentum.
CONDITION: Stable to recovery.
INDICATIONS FOR PROCEDURE: Ms. K is a 30-year-old with a recent diagnosis of serous borderline ovarian cancer of the right ovary, who was counseled and consented to proceed with surgical staging. Of note, the patient has a body mass index of 55 milligrams per kilograms squared, which contributed to the surgical complexity and operative time of this case.
PROCEDURE AND FINDINGS: The patient was taken to the operating room with IV in place. General anesthesia was initiated. She was positioned in the dorsal lithotomy position with her legs in Yellofin stirrups and her arms tucked at her sides. TrenGuard patient positioning system was utilized. Bimanual examination under anesthesia was without abnormality. She was then prepped and draped in the normal sterile fashion.
Foley catheter was placed. A ZUMI uterine manipulator was placed.
An approximately 2 centimeter incision was made in the vertical orientation just below the umbilicus for Hasson open entry. The subcutaneous tissues were separated. The fascia was elevated and incised, and the peritoneum was elevated and sharply incised as well. There were no adhesions at the entry site. The Hasson trocar was inserted and the abdomen was insufflated. The patient was placed in Trendelenburg. Three additional ports were placed, including 5 millimeter ports in the bilateral lower quadrants and a 5 port in the suprapubic location. First, pelvic washings were obtained. Peritoneal biopsies were then obtained including the anterior cul-de-sac, left pelvic sidewall, right pelvic sidewall. The patient did have a 1 nodule in the posterior cul-de-sac that was removed and sent as posterior cul-de-sac nodule. Paracolic gutter biopsies were obtained and then diaphragm scrapings were obtained using saline-soaked endoKittners.
The retroperitoneal space was opened in the paraaortic region. Due to surgical complexity from the patient's morbid obesity as well as negative preoperative imaging, It was not felt to be safe to carry out paraaortic lymphadenectomy. Right pelvic lymphadenectomy was then performed using the LigaSure Maryland electrosurgical device. Nodal tissue was placed in an EndoCatch bag and removed through the umbilical port site under direct visualization. At this point, low-pressure check was performed. Hemostasis was noted throughout. The trocars were removed.
The umbilical incision was then further extended to approximately 5 centimeters and an Alexis retractor was placed. The omentum was delivered through the minilaparotomy, and omentectomy was performed as 2 pieces using the LigaSure Maryland again. The fascia was then closed with 0 PDS in a running fashion. Subcutaneous layer was irrigated and the skin was closed with 4-0 Monocryl. All other skin incisions were closed with 4-0 Monocryl. Uterine manipulator and foley catheter were removed.
Patient tolerated the procedure well. Sponge, lap, and needle counts were correct x2. She was taken to the recovery room in stable condition.
Dictated by: Karen , MD, PhD
I was present and scrubbed for the entire procedure.