No

MR

05

37

12

MEDICAL FACULTY OF CHRISTIAN UNIVERSITY OF INDONESIA

GENERAL HOSPITAL
DEPARTMENT OF OBSTETRY AND GINECOLOGY
JL. Mayjen Sutoyo No. 2 Cawang, Jakarta Timur 13630
Telp.8099217 ext. 108 / 205

SURGERY REPORT

Name: Mrs. Ida Ningrum

Operator
Prof.dr.I.O.Marsis, SpOG
Asistant 1
Dr.Benhur Sibuea
Asistant 2
Jen Marisi Marbun
Pre-surgery diagnose: Dysmenorrhea e.c Adenomyoma

Sex: Female
Anestetic
Instrumentator
Observer

Post- surgery diagnose: Adenomyosis + Adhesion

Technique of operation
1. Total hysterectomy
2. Adhesiolysis

Age: 43 years old

Dr. Gunawarman, SpAn
Zr. Ayup
Sevlin Juliva Tamba
Surgery date: October 30th 2014
Duration time of surgery: 2 hours and 30
minutes
Type of surgery
emergency
minor
policlinic
medium
elective
major

Operation Procedures:
I.

Patient in supine position with general anesthetic

II.

Applying methylene blue in to introitus vagina and installing dower catheter

III.

Asepsis and antisepsis in abdomen region and surrounding the 1/3 distal of
posterior extremity, field of view narrowed by steril doek.

IV.

Pfanenstiel incision on abdomen was made around fibritio tissue, 15 cm

length, the incision was made deeper slice by slice from cutis, subcutis, fascia
then it seperated to lateral section with sharp technique. musculus rectus
abdominis seperated with dull technique, bleeding was taken care off.

V.

Explored the abdominal and pelvic cavity

a. Identified:
-

The uterine as big as a fist, the color is pink, with slippery

surface and smooth and solid consistency.

The right dan left fallopian tube and ovary were normal

Uterine and urinary bladder were adhesed

Conclusion: -Adenomyosis
-Adhesion

b. Total hysterectomy + Adhesiolysis was planned

VI.

Operative procedures of total hysterectomy as follows

a. Fixation uterus by drill
b. The round ligament clamped on two side, approximately 1 cm and 1,5
cm from uterus and then cut both two clamp, ligated at medial and
lateral dissection, then sutured it by Vicrylno.1. The same procedure
is done on the other side.
c. Adhesion of uterine and urinary bladder were released with blunt
technique.
d. Opened plica vesikouterina and continued incision to the left and right
lateral and put aside to lower.
e. The proximal of left fallopian tube was clamped on two side, cut both
two clamped ligated on medial and lateral dissection and then sutured
with Vicrylno.1. The same procedure is done on the right fallopian
tube.
f. The left broad ligament clamped on two side, cut both two clamped,
ligated, then sutured. The same procedure is done on the right broad
ligament.
g. The left uterosacral ligament clamped on two side, approximately 1 cm
and 1,5 cm from uterus, cut between two clamped, ligated on medial
and lateral dissection then sutured with Vicrylno.1. The same
procedure is done on the right uterosacral ligament.
h. The left and right vasa uterin clamped, cut and ligated with
Vicrylno.1
i. The left cardinale ligament clamped on two side, cut between two
clamped, ligated on medial and lateral dissection, then sutured. The
same procedure is done on the right cardinale ligament.

j. Cut off the upper vagina and sutured with Vicryl no.1 by overhecting
suture. And hanged with the right and left round ligament, the right and
left uterosacral ligament and the proximal of left and right fallopian
tube.
k. Reperitonealitation by sutured plica vesikouterin with Chromic Cat
Gut no.2.0
l. Taking of the uterine to pathology anatomy examination
m. Spulling and suction with NaCl 0,9%. Input of Hidrokortison 10 cc to
abdominal cavity

VIII.

After the reperitonealitation had been done abdominal wall was closed, the
peritoneum cavity was cleared from the blood cloth and after sure its no
bleeding then it was sutured slice by slice.
a. Peritoneum parietal was sewed bastes with Plain cat gutno.2.0
b. M.Rectusabdominis was sutured with Chromic cat gut no.2.0
c. Fascia was sutured with Vicrylno.1 by continue
d. Subcutis was sutured with Plain cat gut no.0 by simple suture
e. Cutis was sutured with Chromic cat gut no. 3.0 by subcuticuler

IX.

Bleeding approximately 200 cc

X.

Post surgical wound was cleaned by using Nacl + Betadine, and then it was
closed by using the curapor.

XI.

The abdomen was cleaned.

XII.

The surgery finished.

Post surgery condition:

General condition

: Moderate illness

Consciousness

: Somnolent

Blood pressure

: 120/90 mmHg

Pulse rate

: 72 x/mnt

Respiratory Rate

: 20 x/mnt

Temperature

: 36,5oC

Tissue to Anatomy Patological

Yes: type of tissue :

1. Uterine (October 30th 2014)

No

Operator,

( Prof.dr.I.O.Marsis, SpOG )