- Dictate a problem oriented preoperative note summarizing all previous operative reports, consultations, history, and physical and laboratory findings. Read this note 5 minutes before surgery to focus on the patient’s problems.
- Obtain an operative consent in the office as part of the process of informed consent. Discuss risks, benefits, and alternatives to the procedure.
- Advise the patient not to take any nonsteroidal antiinflammatory drugs (NSAIDs) for 2 weeks before surgery.
- Order mechanical cleansing of bowel and betadine douche the night before surgery.
OPERATING ROOM PREPARATION
- Lower genital tract instruments
Straight catheter in urinary bladder
Uterine dilator in uterus for manipulation
Rectal probe available for manipulation
- Instruments for open laparoscopy
No. 15 scalpel
(2) Narrow S retractors
(2) Short, straight Kocher clamps
(2) Tonsil clamps (Varco clamps)
2-0 Vicryl suture on urology needle for fascia
Hasson laparoscopic cannula
10-mm 180-degree laparoscope j. Video camera
(2) Video monitors, one with photographic printer 1. (2) Short, screw-type 5-mm trocars m. Suction irrigator with Lactated Ringer’s solution n. Calibrated probe
Ovarian biopsy forceps to grasp and palpate lesions p. Bipolar forceps
10-mm 30-degree laparoscope (available) r. 5-mm laparoscope (available)
- Instruments for laparoscopic surgery
10-mm laser-operating laparoscope with coupler
Hot water, to warm laparoscope to body temperature
Sharp scissors (available)
(2) Atraumatic grasping forceps
Monopolar dissecting needle and generator
- Allen stirrups: While awake, the patient is placed in the low thigh dorsal lithotomy position to ensure comfort to back, hips, and lower extremities.
- Left arm: The left armboard should be avoided. The patient’s left arm should be tucked across the chest to increase the right-handed surgeon’s access to the operative field. Comfort reduces fatigue.
- Right arm: The right arm is extended on an armboard to receive the intravenous (IV) fluids.
- General anesthesia: The patient is anesthetized with an intratracheal tube and a warming unit for the upper half of the body to prevent hypothermia during surgery.
- Examination under anesthesia: Betadine preparation and sterile draping; bladder emptied by straight metal catheter. Examine the pelvis thoroughly. Determine the position of the uterus. Insert and fix an intrauterine dilator or HUMI catheter to control uterine movement during the operation. Place straight catheter to drainage in anticipation of an operative laparoscopic surgery.
- Height of operating table for laparoscopy: Height should be adjusted to the comfort of the tallest surgeon; shorter members of the operating team should stand on stools as needed for comfort.
- One surgeon controls the operation: Both diagnostic and operative laparoscopy should be performed by one surgeon. The assistant should assist, not attempt to perform the surgery. The assistant should be still, maintain surgical exposure, and hold the video camera for the surgeon if requested.