Here is a complete, clinically accurate operative note template for a postpartum open tubal ligation (modified Parkland method via minilaparotomy), based on the technique described in Pfenninger and Fowler's Procedures for Primary Care:

Date of Procedure: _______________ Time: _______________

Surgeon: _______________ Assistant: _______________ Anesthesiologist: _______________

Patient: _______________ MRN: _______________ Age: _____ Gravida: _____ Para: _____

Preoperative Diagnosis: Desire for permanent sterilization, postpartum

Postoperative Diagnosis: Status post bilateral tubal ligation

Procedure Performed: Postpartum bilateral tubal ligation via infraumbilical minilaparotomy (Modified Parkland technique)

Anesthesia: [Spinal / Epidural (continued from labor) / General endotracheal anesthesia]

Estimated Blood Loss: < 5 mL

Urine Output: Clear throughout

Specimens: Right and left tubal segments (sent to pathology)

Complications: None

Disposition: Transferred to PACU in stable condition

The patient is a -year-old G___P who delivered vaginally on [date] and presented requesting permanent surgical sterilization. She was counseled extensively regarding the permanent nature of the procedure, failure rates (~1 in 200 lifetime), and alternatives including long-acting reversible contraception. Informed consent was obtained prior to admission. All questions were answered. She confirmed her desire to proceed.

The patient was identified in the holding area and brought to the operating room. She was placed in the supine position. Anesthesia was administered without difficulty. The abdomen was prepped with [Betadine / chlorhexidine] and draped in sterile fashion.

The bladder was drained by [straight catheterization / Foley catheter placement] with [clear / yellow] urine returned.

The uterine fundus was palpated and found to be at the level of [the umbilicus / ___ cm below the umbilicus], consistent with expected postpartum involution. A 2-3 cm curved infraumbilical transverse incision was made with a no. 10 blade. Gentle inferior traction on the abdominal skin was maintained to ensure the scar would be concealed within the umbilical crater.

The incision was carried through the subcutaneous fat. The fascia was identified and incised. Blunt dissection with Kelly clamps was used to enter the peritoneum, favoring the inferior portion of the wound. The peritoneum was entered without difficulty. The total fascial/peritoneal incision was extended to approximately 3-4 cm.

The uterus was gently displaced to the right, bringing the left fallopian tube into view. Babcock clamps were used to grasp and elevate the tube. The tube was traced to its fimbriated end and the left ovary was identified, confirming correct identification of the fallopian tube. The postpartum tube was noted to be edematous and engorged, as expected. Gentle traction was maintained throughout to avoid injury to the mesosalpingeal vessels.

A relatively avascular window in the mesosalpinx was identified in the isthmic portion of the tube. The tube was cross-clamped on each side of the window using straight clamps. Stick ties of 2-0 chromic suture were placed on each side, with a double tie placed on the uterine side. A 2 cm segment of tube was excised and placed in formalin for pathologic examination.

Hemostasis was achieved. The left tube was returned to the abdomen.

The uterus was then gently displaced to the left, and the right fallopian tube was identified and elevated with Babcock clamps in an identical fashion. The right tube was traced to the fimbriated end, and the right ovary was confirmed. An avascular window in the mesosalpinx was identified. The tube was cross-clamped bilaterally, stick-tied with 2-0 chromic suture (double-tied on the uterine side), and a 2 cm segment was excised and sent to pathology.

Hemostasis was confirmed. The abdominal cavity was inspected and found to be without bleeding or injury.

The instrument and sponge counts were confirmed correct.

The abdomen was closed in layers:

The wound was cleaned and a sterile dressing applied.

The Foley catheter was [removed / left in place]. Urine remained clear throughout the procedure.

The patient was extubated / emerged from spinal/epidural anesthesia without difficulty and was transferred to the post-anesthesia care unit in stable condition.

Follow-up: Patient to be seen in [2 weeks] for wound check and pathology review.

Dictated/Signed by: _____________________ Date/Time: _____________________

Source: Pfenninger and Fowler's Procedures for Primary Care, 3rd ed., Chapter 152 - Postpartum Tubal Ligation (sample operative report and technique, pp. 1069-1070)