Welcome. don't know if that helps finish the sentence on your report or not.

• Question regarding inspiration...sm - catzgonewild
  • if only 8 ribs visible, patient's inspiration was not deep enough? better insp. shows 10-11 ribs - ltt
    • Twelve pairs of flexible, archlike ribs form the (sm) - lateral portions of the thoracic cage.
    • Thank you so much...nm - catzgonewild
      • Welcome. don't know if that helps finish the sentence on your report or not. - ltt

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Laparoscopic Bilateral Tubal Ligation Report

Preoperative Diagnosis: Multiparous female desiring permanent sterilization.

Title of Operation: Laparoscopic bilateral tubal ligation with Falope rings

Laparoscopic Bilateral Tubal Ligation

Anesthesia: General endotracheal

Findings At Surgery: Normal uterus, tubes, and ovaries.

Description of Operative Procedure

After informed consent, the patient was taken to the operating room where general anesthesia was administered. The patient was examined under anesthesia and found to have a normal uterus with normal adnexa. She was placed in the dorsal lithotomy position and prepped and draped in sterile fashion. A bivalve speculum was placed in the vagina, and the anterior lip of the cervix was grasped with a single toothed tenaculum. A laparoscopic bilateral tubal ligation uterine manipulator was placed into the endocervical canal and articulated with the tenaculum. The speculum was removed from the vagina.

An infraumbilical incision was made with a scalpel, then while tenting upon the abdomen, a Verres needle was admitted into the intra-abdominal cavity. A saline drop test was performed and noted to be within normal limits. Pneumoperitoneum was attained with 4 liters of carbon dioxide. The Verres needle was removed, and a 10 mm trocar and sleeve were advanced into the intra-abdominal cavity while tenting up on the abdomen. The laparoscope was inserted and proper location was confirmed. A second incision was made 2 cm above the symphysis pubis, and a 5 mm trocar and sleeve were inserted into the abdomen under laparoscopic visualization without complication.

A survey revealed normal pelvic and abdominal anatomy. A Falope ring applicator was advanced through the second trocar sleeve, and the left Fallopian tube was identified, followed out to the fimbriated end, and grasped 4 cm from the cornual region. The Falope ring was applied to a knuckle of tube and good blanching was noted at the site of application. No bleeding was observed from the mesosalpinx. The Falope ring applicator was reloaded, and a Falope ring was applied in a similar fashion to the opposite tube. Carbon dioxide was allowed to escape from the abdomen.

The instruments were removed, and the skin incisions were closed with #3-O Vicryl in a subcuticular fashion. The instruments were removed from the vagina, and excellent hemostasis was noted. The patient tolerated the procedure well, and sponge, lap and needle counts were correct times two. The patient was taken to the recovery room in stable condition.

Examination of his chest, abdomen, and extremities was unremarkable. He had a well healed mid sternotomy incision with some mild s/l cubuloid appearance.

Thanks for your help

xx

thanks for providing these values.  I know there's a difference between arterial and venous blood gases, but i've never typed anything but the arterial ones.  I should probably sit down and memorize these, but my brain is full....

Hi!

I would probably make just a minor adjustment as I think he's talking about edema in both ankles:

EXTREMITIES:  There is edema of the right ankle at the site of fracture times two, trace to 1+ on the left.  Significantly diminished pulses, equal 0-1 DP and PT lower extremities bilaterally.  Normal upper.

As for the rest....looks okay to me...not sure about the "equal" part - sorry!  Good job!

Conus medullaris and the cauda equina are within the normal limits.  Intervertebral disk at L4-5 has mildly diminished signal, indicating desiccation at its interspace.

FINDINGS:  There is a mild bulge centrally with facet osteoarthropathy but no significant canal stenosis. 

**I'm not 100% without actually hearing the dictation that interspace and facet osteoarthropathy are definite, but with years of rad experience that's the best guess I can make for ya, both would be acceptable in that context as you have listed it.  But I at least FINALLY figured out blank #1 (bulge..not bone)!!  Yipee!  LOL Hope this helps ya!   

Reevaluation of osteoarthritis.  Changed to Darvocet, ____ proteinuria.  s/l "effectid".  Using 3-3 per day.  Losing weight.

Diagnosis: Osteoarthritis, hypertension, hypercholesterolemia, and elevated PSA.