Bernadette10
Guru
Would this be 50543 alone or 50543 and 50541-59? The cyst was immediately medial to the tumor and was excised separately, but both were in the RT kidney. Here's the main part of the op note:
POSTOPERATIVE DIAGNOSIS: RT renal mass and complex renal cyst of RT kidney
Pathology showed RT benign serous cortical cyst and low-grade oncocytic cortical neoplasm 5.2 cm
OPERATION: Right robotic assisted laparoscopic partial nephrectomy, laparoscopic ablation of renal cysts
Robotic trocars were placed…
The RT kidney was then mobilized out from its perirenal fat. There were copious amounts of perirenal fat and the patient's kidney capsule had been ingested with the fatty tissue as well requiring additional dissection and added difficulty for this portion of the procedure. Care was taken over the region of the tumor to avoid injuring the capsule or removing the perirenal fat overlying the tumor.
Immediately medial to the mass was seen a complex cystic mass which on CT scan was noted to be a Bosniak 1 or 2 cyst. This was decorticated and ablated and the majority of the complex cystic lesion was left intact and placed in an Endo Catch bag and removed and sent to pathology as right renal cyst.
Once this was accomplished, sonography of the tumor and kidney was performed with the robotic ultrasound probe to delineate the margins of the tumor. This was marked on the kidney capsule with the monopolar scissors. Findings included a well demarcated solid tumor corresponding to the location seen on CT scan. The room was then prepared for clamping, and an adequate number bulldog clamps were brought into the abdomen. An adequate number of sutures were ensured to have been created and the clamp time procedure was reviewed with the operative team. The patient had received at least 2 liters of IV fluid to ensure adequate kidney perfusion.
A bulldog clamp was placed on the main renal artery followed by a second bulldog on the main renal artery. This produced nice blanching of the kidney and the tumor was then excised along the previously planned line of excision beginning with the capsular incision on the far aspect of the renal tumor border proceeding around to the nearer aspect. The tumor was then
resected along a broad front. The incision was then carried down to the level of renal sinus fat and collecting system. The tumor was excised in its entirety without any visible entry into the tumor. Magnified visual inspection was used to confirm healthy parenchyma on either side of the resection.
POSTOPERATIVE DIAGNOSIS: RT renal mass and complex renal cyst of RT kidney
Pathology showed RT benign serous cortical cyst and low-grade oncocytic cortical neoplasm 5.2 cm
OPERATION: Right robotic assisted laparoscopic partial nephrectomy, laparoscopic ablation of renal cysts
Robotic trocars were placed…
The RT kidney was then mobilized out from its perirenal fat. There were copious amounts of perirenal fat and the patient's kidney capsule had been ingested with the fatty tissue as well requiring additional dissection and added difficulty for this portion of the procedure. Care was taken over the region of the tumor to avoid injuring the capsule or removing the perirenal fat overlying the tumor.
Immediately medial to the mass was seen a complex cystic mass which on CT scan was noted to be a Bosniak 1 or 2 cyst. This was decorticated and ablated and the majority of the complex cystic lesion was left intact and placed in an Endo Catch bag and removed and sent to pathology as right renal cyst.
Once this was accomplished, sonography of the tumor and kidney was performed with the robotic ultrasound probe to delineate the margins of the tumor. This was marked on the kidney capsule with the monopolar scissors. Findings included a well demarcated solid tumor corresponding to the location seen on CT scan. The room was then prepared for clamping, and an adequate number bulldog clamps were brought into the abdomen. An adequate number of sutures were ensured to have been created and the clamp time procedure was reviewed with the operative team. The patient had received at least 2 liters of IV fluid to ensure adequate kidney perfusion.
A bulldog clamp was placed on the main renal artery followed by a second bulldog on the main renal artery. This produced nice blanching of the kidney and the tumor was then excised along the previously planned line of excision beginning with the capsular incision on the far aspect of the renal tumor border proceeding around to the nearer aspect. The tumor was then
resected along a broad front. The incision was then carried down to the level of renal sinus fat and collecting system. The tumor was excised in its entirety without any visible entry into the tumor. Magnified visual inspection was used to confirm healthy parenchyma on either side of the resection.