# Open thoracotomy & decortication



## ksb0211 (Apr 27, 2011)

We don't do a lot of pulmonary surgeries, so I'm hoping for some guidance.  I don't want to mis-code.
Thanks.

PROCEDURE/OPERATION
Attempted thoracoscopy with open thoracotomy and decortication.

DESCRIPTION OF PROCEDURE
The patient was taken to the operating room and after induction of adequate general anesthesia the patient was prepped with DuraPrep and draped sterilely.  A dual-lumen tube was utilized.  The patient was in a left lateral position for a right posterolateral thoracoscopy.  The patient had a thoracostomy tube in place.  This was removed.  The scope was introduced through this and it was clear that there was much fibrinous debris and a thick peel that would not be readily addressed thoracoscopically.  The chest was opened utilizing the muscle sparing incision below the level of the scapula in line with the ribs.  The latissimus dorsi was retracted posteriorly and serratus anterior anteriorly.   The ribs were exposed.  The chest was entered.  The patient was noted to have a marked pleural peel with a fibrinous type exudate over the parietal and visceral pleura more inferiorly than superiorly.  The diaphragm was completely covered as was the lower and middle lobe.  This extended into the gutters and on to the pericardium.  This was carefully dissected utilizing right angle clamps and pickups primarily with some blunt dissection.  Ultimately most of the peel was removed.  The lung could be blown and well re-expanded.  Cultures were taken.  The patient did have significant oozing.  The angled 36s and straight 36 chest tubes were then placed.  The lung appeared to expand well.  No marked air leak was noted.  All obvious peel was fairly well resected with good expansion of the middle and lower lobes.   The upper lobe was largely unaffected.  The ribs were then reapproximated with interrupted figure-of-eight sutures of #1 Vicryl.  The musculature was returned to its previous position and then the subcutaneous tissue was closed with running #1 Vicryl suture.  Clips were applied to the skin.  A 10 mm Jackson-Pratt drain was placed within the wound.  A dry sterile dressing was applied.  The patient tolerated the procedure.  Estimated blood loss was perhaps 800 mL.


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## daharden (Apr 27, 2011)

32320-rt


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