Checklist for Ovarian cystectomy

Preoperative Checklist
The pdf form of the Ovarian Cystectomy Checklist may not contain the latest changes

(Please indicate   - Done,   X - Not done,   NA – Not applicable) Too much damage to functional ovarian tissue or tube Premature menopause Decreased fertility Ectopic pregnancy Spreading unanticipated malignancy Spillage of caustic/irritant material (18%) Recurrence of ovarian cyst Unintentionally leave behind necrotic tissue Ureteral injury Persistent pain (prevent unreasonable expectations of surgery)
 * 1) ___ Image ovary/adnexa using transvaginal ultrasound (prevent spreading unanticipated malignancy)
 * 2) ___ Obtain serum specimen for CA-125 antigen (monitor post operative progress if malignancy found)
 * 3) ___ Check interspinous distance for possible transverse incision length (prevent inability to perform surgery through incision)
 * 4) ___ Check umbilical to symphysis distance for possible infraumbilical incision length (prevent inability to perform surgery through incision)
 * 5) ___ Determine chance of malignancy (prevent inability to perform surgery through incision)
 * 6) ___ Choose incision type – Pfannenstiel, midline, Maylard based on history and physical exam (prevent inability to perform surgery through incision)
 * 7) ___ Inform patient of wound complications and their likelihood of occurrence  (wound infection, hematoma, dehiscence, pain, cosmetic changes) along with complications of the primary procedures being performed (prevent incorrect expectations)
 * 8) ___ Inform patient and sign consent for possible complications: bleeding, Infection/abscess
 * 1) ___ Recommend to clip abdominal/mons hair prior to surgery but no shaving (prevent infection)
 * 2) ___ Recommend to shower/cleanse incision site  prior to surgical prep with antibacterial soap (prevent infection)
 * 3) ___ Order mechanical bowel prep for the day before surgery (prevent bowel injury) (prevent inadequate visualization)
 * 4) ___ Order prophylactic antibiotics, at least 30-60 minutes before incision and consider repeating antibiotics (up to three doses) for high risk patients (prevent cuff abscess)
 * 5) ___ Discontinue ASA (5 days preop), Plavix (3 days preop) and other anti-clotting meds prior to surgery
 * 6) ___ Be familiar with myomectomy, subtotal hysterectomy, coring, bivalving, and  morcellation techniques to reduce uterine mass (prevent inability to perform surgery through incision)
 * 7) ___Be familiar with intrafascial hysterectomy technique (prevent ureter/bladder injury)

Cautery Management

 * 1) ___ Confirm that patient is grounded (prevent cautery injury)
 * 2) ___ When cauterizing using metal instruments check for any unintended skin/tissue contact (prevent cautery injury)