sandy06
Networker
PREOPERATIVE DIAGNOSIS:
Metastatic colon carcinoma with spinal metastasis to the thoracic
spine with intractable pain.
POSTOPERATIVE DIAGNOSIS:
Metastatic colon carcinoma with spinal metastasis to the thoracic
spine with intractable pain.
PROCEDURE:
The thoracic portion of the case consisted of obtaining exposure for
an anterior approach for Dr. T of neurosurgery The
operative procedure was a double right thoracotomy for exposure of a
4-level thoracic body corpectomy with anterior instrumentation.
SURGEON:
, M.D.
The neurosurgical portion of the case was completed by Dr. T.
DESCRIPTION OF PROCEDURE:
After having appropriate monitoring lines placed by anesthesia,
patient received preoperative antibiotics. The patient was brought to
the operating room. The patient was hooked to spinal cord integrity
monitoring. The patient was then positioned in a right posterolateral
thoracotomy position. Prior to positioning the patient had a Carlens
double lumen endotracheal tube placed. The position of the tube was
verified under fiberoptic bronchoscopy.
Once the patient was positioned in a posterolateral thoracotomy
position, fluoroscopy was brought onto the field. The area of
interest was then marked and identified utilizing fluoroscopy.
Because of the level of exposure that was required this approach
required a 2-level thoracotomy. The patient was then prepped and
draped in the usual sterile fashion. Thereafter an appropriate
surgical time-out was taken.
The initial thoracotomy incision was performed over the 4th
intercostal space, was curvilinear and carried out just beneath the
tip of the scapula and then cephalad from that direction. The
dissection was carried down through the latissimus dorsi posteriorly.
The serratus anterior was elevated was reflected anteriorly.
Thereafter the right lung was deflated. The chest was then entered
through the 4th intercostal space. Thereafter a small Tuffier
retractor was placed inside the wound and was gently used to spread
the interspace. The intercostal muscles were divided both anteriorly
and posteriorly. Thereafter a 2nd counter incision at a lower level,
a smaller limited lateral thoracotomy incision was carried out over
the 9th intercostal space. The muscle layers and intercostal muscles
were divided in the same fashion.
Thereafter direct inspection of the spine was carried out. The
decision was made to resect a portion of the 8th rib and to notch the
5th rib posteriorly so as to create a larger space of unimpeded
exposure. Thereafter, once the exposure was deemed to be adequate,
the posterior pleura was opened, the azygos vein was divided, and the
case was then endorsed over to Dr. L for the thoracic surgical
portion of the case.
Upon completion of the thoracic surgical portion of the case, routine
closure was carried out utilizing number 1 Vicryl pericostal sutures
at both levels, the muscle and fascia layers were approximated in
anatomical layers utilizing running 0 Vicryl suture, the skin
closures were completed utilizing 4-0 Monocryl and were reinforced
utilizing Octylseal prior to completing the closure. A number 32
chest tube was placed in the posterior dependent portion of the right
chest, was brought out and was secured utilizing a 0 Ethibond suture,
and was hooked to Pleur-evac drainage.
Can some one please give and insight on this Opt Report, I don't know where to begin to look for a code, this is so confussing to me...
thanks in advance for any hint you can give
Metastatic colon carcinoma with spinal metastasis to the thoracic
spine with intractable pain.
POSTOPERATIVE DIAGNOSIS:
Metastatic colon carcinoma with spinal metastasis to the thoracic
spine with intractable pain.
PROCEDURE:
The thoracic portion of the case consisted of obtaining exposure for
an anterior approach for Dr. T of neurosurgery The
operative procedure was a double right thoracotomy for exposure of a
4-level thoracic body corpectomy with anterior instrumentation.
SURGEON:
, M.D.
The neurosurgical portion of the case was completed by Dr. T.
DESCRIPTION OF PROCEDURE:
After having appropriate monitoring lines placed by anesthesia,
patient received preoperative antibiotics. The patient was brought to
the operating room. The patient was hooked to spinal cord integrity
monitoring. The patient was then positioned in a right posterolateral
thoracotomy position. Prior to positioning the patient had a Carlens
double lumen endotracheal tube placed. The position of the tube was
verified under fiberoptic bronchoscopy.
Once the patient was positioned in a posterolateral thoracotomy
position, fluoroscopy was brought onto the field. The area of
interest was then marked and identified utilizing fluoroscopy.
Because of the level of exposure that was required this approach
required a 2-level thoracotomy. The patient was then prepped and
draped in the usual sterile fashion. Thereafter an appropriate
surgical time-out was taken.
The initial thoracotomy incision was performed over the 4th
intercostal space, was curvilinear and carried out just beneath the
tip of the scapula and then cephalad from that direction. The
dissection was carried down through the latissimus dorsi posteriorly.
The serratus anterior was elevated was reflected anteriorly.
Thereafter the right lung was deflated. The chest was then entered
through the 4th intercostal space. Thereafter a small Tuffier
retractor was placed inside the wound and was gently used to spread
the interspace. The intercostal muscles were divided both anteriorly
and posteriorly. Thereafter a 2nd counter incision at a lower level,
a smaller limited lateral thoracotomy incision was carried out over
the 9th intercostal space. The muscle layers and intercostal muscles
were divided in the same fashion.
Thereafter direct inspection of the spine was carried out. The
decision was made to resect a portion of the 8th rib and to notch the
5th rib posteriorly so as to create a larger space of unimpeded
exposure. Thereafter, once the exposure was deemed to be adequate,
the posterior pleura was opened, the azygos vein was divided, and the
case was then endorsed over to Dr. L for the thoracic surgical
portion of the case.
Upon completion of the thoracic surgical portion of the case, routine
closure was carried out utilizing number 1 Vicryl pericostal sutures
at both levels, the muscle and fascia layers were approximated in
anatomical layers utilizing running 0 Vicryl suture, the skin
closures were completed utilizing 4-0 Monocryl and were reinforced
utilizing Octylseal prior to completing the closure. A number 32
chest tube was placed in the posterior dependent portion of the right
chest, was brought out and was secured utilizing a 0 Ethibond suture,
and was hooked to Pleur-evac drainage.
Can some one please give and insight on this Opt Report, I don't know where to begin to look for a code, this is so confussing to me...
thanks in advance for any hint you can give