sandy06
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PREOPERATIVE DIAGNOSIS:
Adenocarcinoma of the ascending colon.
POSTOPERATIVE DIAGNOSIS:
Adenocarcinoma of the ascending colon.
PROCEDURE:
Laparoscopically assisted right hemicolectomy.
ANESTHESIA:
General
POSITION:
Lithotomy candy-cane stirrups.
BLOOD LOSS:
Less than 10 mL, replacement none.
INDICATIONS:
The patient is a white female, who was found to have an adenocarcinoma
of the ascending colon presenting now for procedure. Risks, benefits
and options have been discussed. All questions were answered.
PROCEDURE:
Patient brought to the operating theater, induced under general
anesthesia. After time-out protocol was performed and Foley catheter
been placed, as well as a nasogastric decompression. The patient was
then prepped and draped in the usual sterile fashion. A small incision
was made in the left subcostal position in using an Optiview port the
abdomen was penetrated and insufflated with 15 mmHg. A left lower
quadrant and left midaxillary ports were then both placed under direct
visualization. The patient was then placed in steep Trendelenburg
position, rotated to the patient's left. At this point, the
examination of the abdomen had been performed. The liver appeared to
be free of any gross lesions. The small bowel from ligament of Treitz
to the terminal ileum appeared to be normal at which point, we were
able to immediately identify the lesion. At this point, starting in
the cecum, the cecum and ascending colon were mobilized medially along
the white line of Toldt up toward the hepatic flexure. Then the
attention was then directed to the mid transverse colon where the
omentum was dissected from the colon up toward the hepatic flexure.
The hepatic flexure was then taken down carefully using sharp and
blunt dissection using the Harmonic scalpel. We were able to
immediately identify the duodenum which was kept out of harm's way.
Once we had complete mobilization, a small transverse incision was
made in the right upper quadrant. Using muscle splitting the abdomen
was then entered and wound protector applied. The bowel was then
brought up through this incision. Proximal distal resection margins
were identified, chosen, divided using a linear stapler. The mesentery
had been taken using the Impact LigaSure. The specimen was then handed
off for immediate evaluation by pathology fresh. At this point, the
mesentery was approximated in a running fashion using Vicryl. Using a
functional end-to-end anastomosis was then constructed using a linear
stapler and TA device. All suture lines were inspected and noted to be
hemostatic and had been oversewn. At this point, irrigation was
performed. Irrigation was clear and aspirated completely. Abdominal
contents were then allowed to return to their anatomical position. The
incision was then closed in layers with the skin approximated with
subcuticular 4-0 Monocryl. Dermabond and sterile dressings were
applied, as with the trocar sites. Instrument, sponge and lap counts
were all correct. The patient was then brought to recovery room in
stable condition.
Can someone please give me some insight on how to code this case, I'm very confuse.
Thanks in advance for your help.....
Adenocarcinoma of the ascending colon.
POSTOPERATIVE DIAGNOSIS:
Adenocarcinoma of the ascending colon.
PROCEDURE:
Laparoscopically assisted right hemicolectomy.
ANESTHESIA:
General
POSITION:
Lithotomy candy-cane stirrups.
BLOOD LOSS:
Less than 10 mL, replacement none.
INDICATIONS:
The patient is a white female, who was found to have an adenocarcinoma
of the ascending colon presenting now for procedure. Risks, benefits
and options have been discussed. All questions were answered.
PROCEDURE:
Patient brought to the operating theater, induced under general
anesthesia. After time-out protocol was performed and Foley catheter
been placed, as well as a nasogastric decompression. The patient was
then prepped and draped in the usual sterile fashion. A small incision
was made in the left subcostal position in using an Optiview port the
abdomen was penetrated and insufflated with 15 mmHg. A left lower
quadrant and left midaxillary ports were then both placed under direct
visualization. The patient was then placed in steep Trendelenburg
position, rotated to the patient's left. At this point, the
examination of the abdomen had been performed. The liver appeared to
be free of any gross lesions. The small bowel from ligament of Treitz
to the terminal ileum appeared to be normal at which point, we were
able to immediately identify the lesion. At this point, starting in
the cecum, the cecum and ascending colon were mobilized medially along
the white line of Toldt up toward the hepatic flexure. Then the
attention was then directed to the mid transverse colon where the
omentum was dissected from the colon up toward the hepatic flexure.
The hepatic flexure was then taken down carefully using sharp and
blunt dissection using the Harmonic scalpel. We were able to
immediately identify the duodenum which was kept out of harm's way.
Once we had complete mobilization, a small transverse incision was
made in the right upper quadrant. Using muscle splitting the abdomen
was then entered and wound protector applied. The bowel was then
brought up through this incision. Proximal distal resection margins
were identified, chosen, divided using a linear stapler. The mesentery
had been taken using the Impact LigaSure. The specimen was then handed
off for immediate evaluation by pathology fresh. At this point, the
mesentery was approximated in a running fashion using Vicryl. Using a
functional end-to-end anastomosis was then constructed using a linear
stapler and TA device. All suture lines were inspected and noted to be
hemostatic and had been oversewn. At this point, irrigation was
performed. Irrigation was clear and aspirated completely. Abdominal
contents were then allowed to return to their anatomical position. The
incision was then closed in layers with the skin approximated with
subcuticular 4-0 Monocryl. Dermabond and sterile dressings were
applied, as with the trocar sites. Instrument, sponge and lap counts
were all correct. The patient was then brought to recovery room in
stable condition.
Can someone please give me some insight on how to code this case, I'm very confuse.
Thanks in advance for your help.....