Of these, a total of 540 cases of diagnostic and/or operative laparoscopy selleck chemicals with and without hysteroscopy for unexplained infertility were identified. These cases were selected as they are usually intended as a careful surveillance of pelvic anatomy in order to identify an etiology of infertility. As the goal of these surgical cases is the identification of anatomy, it was thought fit that these operative reports would focus on the description of anatomy. All operative reports commented on the uterus, tubes, and ovaries (100%), which reflect parts of zone I and part of zone III. Only 17% (n = 93, 95% CI: 13.8�C20.2) commented on the dome of the bladder and the anterior cul-de-sac (the remainder of zone I). Twenty-four percent (n = 130, 95% CI: 20.4�C27.6) commented on the posterior cul-de-sac, which represents part of zone II.

Interestingly, only one fourth of those who addressed zone II (6%; n = 34, 95% CI: 4�C8) commented on the rectosigmoid. Moreover, only 5% (29/540) commented on the pelvic sidewall peritoneum without specifying whether the ovarian fossa and the peritoneum overlying zone IV were evaluated. Overall, only 6% (n = 34, 95% CI: 4�C8) reported either positive and/or negative findings in the various pelvic zones resulting in complete documentation of the presence or absence of pelvic findings (Table 2). Supplemental photographic documentation of all pelvic areas was frequently missed; it was found only in 6% (n = 34, 95% CI: 4�C8) of patients’ charts. Table 2 Percentages of the surgical reports that described findings in any structure or all structures of every pelvic zone.

4. Conclusion The paucity of detail in operative reporting represents a missed opportunity to document important anatomical findings that could prove useful in future patient care. Our retrospective chart review demonstrated that description of important pelvic structures is frequently missing in operative notes from diagnostic and operative laparoscopy. The anterior cul-de-sac, deep inguinal rings, ovarian fossa, and the lateral pelvic sidewall peritoneum are the most frequently missed areas. Photographic documentation of normal and abnormal findings was also frequently missed. As seen in the general surgical literature, standardizing operative reporting improves completeness of documentation [2]. If such systems are in place, residents can be taught these methods for reporting during their training [3, 4].

As the era of digital photography and electronic medical records evolves, this is a very appropriate time to innovate Brefeldin_A with respect to the methods by which we document our surgical findings. Implementation of a systematic approach for laparoscopic pelvic examination will indeed enhance the diagnostic accuracy, help diagnose lesions in anatomically challenging locations, and provide the required standardization with its clinical and academic advantages.