bmanus
Guru
any help with this would be great.
DETAILED OPERATIVE REPORT: The patient was brought to the operating
room. She was intubated with double-lumen tube and then placed in the
left lateral decubitus position with the right side up. A 1 cm incision
was made in the 8th interspace in the mid axillary line and the chest
was entered with a 10 mm 30 degree scope. A 2.5 cm working port
incision was made in the 5th interspace in the medial position. There
was good lung isolation. We initially took down the inferior pulmonary
ligament. There was no level 9 lymph nodes seen. There was no level 8
lymph nodes seen. We dissected along the visceral pleura along the
pericardium and the inferior pulmonary vein up to the level of the
carinal packet. A number of lymph nodes were taken here and sent for
permanent analysis. We then performed a dissection in the peritracheal
space lateral to the superior vena cava. We removed a number of level 2
and level 4 lymph nodes from this position. These were also sent for
permanent. We then performed a generous wedge resection of the right
upper lobe using multiple fires of the Endo-GIA green load stapler
buttressed with the peri strips. The specimen was put in an EndoCatch
bag and removed through the utility incision. There was good gross
margin clearance. The tumor was palpable with possible visceral pleural
involvement. There was no parietal pleural involvement seen. The CVM
mesh was then brought by Dr. Cr to the operating room and was
trimmed to within 1 cm of the CVM beads. The mesh was then placed over
the staple line and sutured with Prolene suture and also clipped and
stapled at one end. There was good coverage of the mesh over the
residual lung parenchyma. A multilevel Marcaine rib block was performed
with 0.5 percent Marcaine. A 20 French chest tube was placed through
the camera port posterior to the apex. The utility incision was closed
with absorbable suture. The patient tolerated the procedure well. The
lung inflated nicely. She was returned to the supine position,
extubated and taken to recovery in stable condition.
DETAILED OPERATIVE REPORT: The patient was brought to the operating
room. She was intubated with double-lumen tube and then placed in the
left lateral decubitus position with the right side up. A 1 cm incision
was made in the 8th interspace in the mid axillary line and the chest
was entered with a 10 mm 30 degree scope. A 2.5 cm working port
incision was made in the 5th interspace in the medial position. There
was good lung isolation. We initially took down the inferior pulmonary
ligament. There was no level 9 lymph nodes seen. There was no level 8
lymph nodes seen. We dissected along the visceral pleura along the
pericardium and the inferior pulmonary vein up to the level of the
carinal packet. A number of lymph nodes were taken here and sent for
permanent analysis. We then performed a dissection in the peritracheal
space lateral to the superior vena cava. We removed a number of level 2
and level 4 lymph nodes from this position. These were also sent for
permanent. We then performed a generous wedge resection of the right
upper lobe using multiple fires of the Endo-GIA green load stapler
buttressed with the peri strips. The specimen was put in an EndoCatch
bag and removed through the utility incision. There was good gross
margin clearance. The tumor was palpable with possible visceral pleural
involvement. There was no parietal pleural involvement seen. The CVM
mesh was then brought by Dr. Cr to the operating room and was
trimmed to within 1 cm of the CVM beads. The mesh was then placed over
the staple line and sutured with Prolene suture and also clipped and
stapled at one end. There was good coverage of the mesh over the
residual lung parenchyma. A multilevel Marcaine rib block was performed
with 0.5 percent Marcaine. A 20 French chest tube was placed through
the camera port posterior to the apex. The utility incision was closed
with absorbable suture. The patient tolerated the procedure well. The
lung inflated nicely. She was returned to the supine position,
extubated and taken to recovery in stable condition.
