TWilliam2019
Guru
1. Right VATS with evacuation of parapneumonic effusion
2. Right upper lobe wedge biopsy of pulmonary nodule
3. Right multilevel intercostal nerve block
4. Left open thoracostomy/chest tube placement, 28 French
? IS THIS CORRECT ?
32666 RT
32550
Procedure in detail:
The patient had his history and physical updated prior to the procedure. He was transferred to the operating suite placed on the operating table where he underwent general anesthesia with double-lumen endotracheal intubation. Monitoring lines and devices were placed by anesthesia. The patient was then placed in the lateral, position with the right chest facing up. The right chest was prepped and draped in usual sterile fashion using ChloraPrep solution. Timeout was used to confirm patient identity as well as the procedure to be performed. Antibiotics were given prior to the incisions.
A 10 mm incision was made in the posterior axillary line, roughly the eighth intercostal space. The deep dermis and subcutaneous tissues were divided with electrocautery. The musculature was divided and access into the right pleural space was achieved near the costophrenic angle. Gross inspection revealed chronic adhesions involving the lateral aspect of the lung, but the VATS camera could be maneuvered around these adhesions. There was a large amount of purulent fluid within the right pleural space. A 10 mm port was placed anteriorly and a third 10 mm port was placed near the cardiophrenic angle under direct visualization. A total of 1200 mL of purulent fluid was removed from the space. Portions of this was submitted for cultures, cytology, as well as cell count.
The right pleural space was then irrigated with saline and suctioned out. The right upper lobe appeared to have a pleural-based nodule anteriorly. Using a thick tissue stapling load, a wedge resection was performed of this nodule and submitted to pathology for routine evaluation. A 28 French straight chest tube was then placed in position at the apex. A multilevel intercostal nerve block was performed by injecting half percent Marcaine and interspaces 5 through 8. Once completed, the lung was ventilated and the VATS camera was removed. The soft tissues were reapproximated with 2-0 Vicryl. The skin was closed with 4-0 Monocryl in a running subcuticular manner. Dermabond was placed over the wounds. The chest tube was secured with 0 silk and 0 Ethibond.
The patient was then placed in the supine position and the left chest was bumped. The left lateral chest wall was then prepped and draped with ChloraPrep solution in the usual sterile fashion. The soft tissues were injected with half percent Marcaine for local anesthesia. At approximately the mid axillary line, roughly the fifth or sixth intercostal space, a 10 mm incision was made. Electrocautery was used to divide the subcutaneous tissue as well as the muscular tissue and access into the left pleural space was achieved. Immediately upon entering the left pleural space, a large rush of purulent fluid was identified. Portions of this was submitted for cytology, as the patient already had preoperative cultures pending from the thoracentesis. A total of 1500 mL was then removed from the left pleural space. A 28 French straight chest tube was then placed for ongoing drainage and secured in similar fashion as previously described.
The patient tolerated the procedure well, was extubated, then transferred to recovery.
2. Right upper lobe wedge biopsy of pulmonary nodule
3. Right multilevel intercostal nerve block
4. Left open thoracostomy/chest tube placement, 28 French
? IS THIS CORRECT ?
32666 RT
32550
Procedure in detail:
The patient had his history and physical updated prior to the procedure. He was transferred to the operating suite placed on the operating table where he underwent general anesthesia with double-lumen endotracheal intubation. Monitoring lines and devices were placed by anesthesia. The patient was then placed in the lateral, position with the right chest facing up. The right chest was prepped and draped in usual sterile fashion using ChloraPrep solution. Timeout was used to confirm patient identity as well as the procedure to be performed. Antibiotics were given prior to the incisions.
A 10 mm incision was made in the posterior axillary line, roughly the eighth intercostal space. The deep dermis and subcutaneous tissues were divided with electrocautery. The musculature was divided and access into the right pleural space was achieved near the costophrenic angle. Gross inspection revealed chronic adhesions involving the lateral aspect of the lung, but the VATS camera could be maneuvered around these adhesions. There was a large amount of purulent fluid within the right pleural space. A 10 mm port was placed anteriorly and a third 10 mm port was placed near the cardiophrenic angle under direct visualization. A total of 1200 mL of purulent fluid was removed from the space. Portions of this was submitted for cultures, cytology, as well as cell count.
The right pleural space was then irrigated with saline and suctioned out. The right upper lobe appeared to have a pleural-based nodule anteriorly. Using a thick tissue stapling load, a wedge resection was performed of this nodule and submitted to pathology for routine evaluation. A 28 French straight chest tube was then placed in position at the apex. A multilevel intercostal nerve block was performed by injecting half percent Marcaine and interspaces 5 through 8. Once completed, the lung was ventilated and the VATS camera was removed. The soft tissues were reapproximated with 2-0 Vicryl. The skin was closed with 4-0 Monocryl in a running subcuticular manner. Dermabond was placed over the wounds. The chest tube was secured with 0 silk and 0 Ethibond.
The patient was then placed in the supine position and the left chest was bumped. The left lateral chest wall was then prepped and draped with ChloraPrep solution in the usual sterile fashion. The soft tissues were injected with half percent Marcaine for local anesthesia. At approximately the mid axillary line, roughly the fifth or sixth intercostal space, a 10 mm incision was made. Electrocautery was used to divide the subcutaneous tissue as well as the muscular tissue and access into the left pleural space was achieved. Immediately upon entering the left pleural space, a large rush of purulent fluid was identified. Portions of this was submitted for cytology, as the patient already had preoperative cultures pending from the thoracentesis. A total of 1500 mL was then removed from the left pleural space. A 28 French straight chest tube was then placed for ongoing drainage and secured in similar fashion as previously described.
The patient tolerated the procedure well, was extubated, then transferred to recovery.