Description of Event or Problem · 0
THE PATIENT ARRIVED FOR ELECTIVE RADIO FREQUENCY FIBROID ABLATION; HYSTEROSCOPY SURGERY. AFTER CONFIRMING APPROPRIATE CONSENTS FOR SURGERY, THE PATIENT WAS PREPPED AND TAKEN TO THE OPERATING ROOM WITH IV HANGING. CONSENTS WERE VERIFIED AND TIME-OUT PROCEDURE WAS DONE. GENERAL ENDOTRACHEAL ANESTHESIA WAS ADMINISTERED WITHOUT EVENT. THE PATIENT WAS THEN PLACED IN DORSAL LITHOTOMY POSITION, PREPPED, AND DRAPED IN THE USUAL STERILE MANNER. A SPECULUM WAS PLACED WITHIN THE VAGINA AND A SINGLE-TOOTH TENACULUM WAS PLACED ON THE ANTERIOR LIP OF THE CERVIX. VASOPRESSIN WAS INSTILLED IN THE MANNER OF A CERVICAL BLOCK AT 3 AND 9 O'CLOCK. DILATATION WAS PERFORMED UNTIL THE UTERINE CAVITY WAS ACCESSED. ATTENTION WAS TURNED TO THE ABDOMEN WHERE A VERESS NEEDLE WAS INTRODUCED IN A 5 MM INCISION. PNEUMOPERITONEUM WAS CREATED. A 5 MM TROCAR WAS THEN INSERTED AND THE CAMERA PLACED WITHIN IT. A SECOND 12 MM INCISION WAS THEN MADE IN THE IN THE SUPRAUMBILICAL AREA WHERE A TROCAR OF THAT SIZE WAS THEN INTRODUCED. A THIRD INCISION WAS MADE IN THE LEFT LOWER QUADRANT FOR INTRODUCTION OF A SECOND 5 MM TROCAR. THE GRASPERS WERE USED TO ADDRESS THE APPEARANCE OF WHAT WAS THE OMENTUM ATTACHED TO THE POSTERIOR FUNDAL AREA OF THE UTERUS ABOVE THE LOOP OF BOWEL. THE SMALL BOWEL APPEARED TO BE DENSELY ADHERED TO THE POSTERIOR (RIGHT) SIDE OF THE UTERUS. THE LIGA SURE WAS THEN INTRODUCED INTO THE 3RD TROCAR AND CAREFUL DISSECTION WITH LIGATURE AND PICKUPS WERE USED TO CLEAR THE OMENTUM FROM THE SURFACES OF THE UTERUS. THE PATIENT WAS PLACED IN TRENDELENBURG POSITION. THE UTERUS WAS ASSESSED USING AN ULTRASOUND PROBE AND MULTIPLE FIBROIDS WERE NOTED. ALSO, THERE WERE FIBROIDS ON THE SURFACE. A TOTAL OF 6 FIBROIDS WERE TREATED TO SUPERFICIAL USING LINE OF SIGHT, 1 TO 2 CM OR LESS AND FOUR MORE FIBROIDS WERE TREATED, THE LARGEST OF WHICH WAS 3.5 X 3.5 CM, AND THAT FIBROID GOT 3 DEPLOYMENTS FOR IT TO HAVE SHRUNKEN. ALL SURFACES WERE NOTED TO BE HEMOSTATIC ALONG WITH IRRIGATION. ALL FLUIDS WERE SUCTIONED FROM THE ABDOMEN. ATTENTION WAS TURNED AGAIN TO THE UTERUS WHERE AN ENDOCERVICAL CURETTE WAS INTRODUCED. CURETTAGE WAS PERFORMED AGAIN OF THE UTERINE CAVITY AND HANDED OFF THE FIELD. THERE WERE NO OBSERVATIONS OF ANY PERFORATION. THE PNEUMOPERITONEUM WAS RELIEVED. ALL TROCARS WERE REMOVED FROM THE ABDOMEN. ALL SKIN WAS SUTURED. GENERAL ENDOTRACHEAL ANESTHESIA WAS DISCONTINUED. THE PATIENT WAS AWAKENED, EXTUBATED, AND TRANSFERRED TO RECOVERY ROOM AWAKE AND IN STABLE CONDITION. PT TRANSFERRED TO PRE-OP FOR DISCHARGE. PT WAS ASSISTED WITH DRESSING AND WAS GIVEN DISCHARGE DIRECTIONS. PT ASKED WHEN SHE COULD EAT AND WANTED TO KNOW WHEN SHE COULD TAKE HER IBUPROFEN. PT BECAME VERY LETHARGIC WHEN SHE WAS BEING ASSISTED TO THE WHEELCHAIR. PATIENT WAS PLACED BACK ONTO THE STRETCHER AND MOVED TO A DIFFERENT RECOVERY BAY FOR MONITORING. PT WAS RESPONSIVE TO COMMANDS. THE PATIENT'S BP CONTINUED TO IMPROVE BUT PROGRESSIVELY AND RAPIDLY DECOMPENSATED AND PT RETURNED TO THE OPERATING ROOM FOR EXPLORATORY SURGERY.