jtb57chevy
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I'm new to cardiothoracic and would appreciate an experienced eye. I have 33533 -LIMA to LAD. Is there anything to code for the work of adding the SVG to lengthen the original graft? How about for the use of the robotics?
Thanks so much for any help
Robotically harvested left internal mammary artery, LIMA to the LAD
DESCRIPTION OF PROCEDURE: The patient was placed in supine position on the operating room table and informed consent had been obtained. After general endotracheal intubation with double-lumen endotracheal tube, the patient was placed with the left side slightly cocked up with a roll below the shoulder blade. The patient was sterilely prepped and draped in normal fashion, single lung ventilation. Three incisions were made about the left chest wall at the level of the anterior axillary line, at the level of the third, fifth, and seventh interspace. A 30 degree camera was placed through the middle port. This guided placement of the additional trocars. A bipolar grasper was placed in one port, and a flat tipped cautery in the other. The left internal mammary artery was visualized very well. It was harvested with a 1 cm intrathoracic fascial pedicle from the subclavian down to the muscle just before the diaphragm.
The patient was systemically heparinized. The mammary was doubly ligated distally and transected. The pericardium had been opened. The LAD was an excellent target vessel. The robotic system was then removed. A small anterior thoracotomy incision was made into the fifth interspace, incorporating the camera port. A retractor was placed. The pericardium was opened. The LAD was easily identified in the center of the wound. The mammary artery was prepared for anastomosis. There was however in the distal centimeter a dissection of the vessel, so the mammary was trimmed back. However, this left us with a shorter length and because of this a small segment of saphenous vein was harvested from the left ankle. In an end-to-end fashion the vein graft was anastomosed to the mammary. The LAD was then exposed with a footed retractor. The vessel was entered. A 2 mm intercoronary shunt was placed and the distal anastomosis was then constructed using 7-0 Prolene suture.
Flow probe analysis revealed superb biphasic flow. Echocardiography showed normal left ventricular function. Protamine was administered without any adverse effects. Mammary pedicle was tacked to the heart. A single 32-French chest tube was passed through a lower port and secured to the skin with heavy silk suture. The wound was thoroughly irrigated with excellent hemostasis. The ribs were approximated with paracostal Vicryl. The subcutaneous tissues and muscle were approximated with Vicryl, the skin with Monocryl, and sterile dressings were applied. The patient was taken in stable condition to the open heart recovery room.
FINDINGS: Normal LV function. Good target vessel.
Thanks so much for any help
Robotically harvested left internal mammary artery, LIMA to the LAD
DESCRIPTION OF PROCEDURE: The patient was placed in supine position on the operating room table and informed consent had been obtained. After general endotracheal intubation with double-lumen endotracheal tube, the patient was placed with the left side slightly cocked up with a roll below the shoulder blade. The patient was sterilely prepped and draped in normal fashion, single lung ventilation. Three incisions were made about the left chest wall at the level of the anterior axillary line, at the level of the third, fifth, and seventh interspace. A 30 degree camera was placed through the middle port. This guided placement of the additional trocars. A bipolar grasper was placed in one port, and a flat tipped cautery in the other. The left internal mammary artery was visualized very well. It was harvested with a 1 cm intrathoracic fascial pedicle from the subclavian down to the muscle just before the diaphragm.
The patient was systemically heparinized. The mammary was doubly ligated distally and transected. The pericardium had been opened. The LAD was an excellent target vessel. The robotic system was then removed. A small anterior thoracotomy incision was made into the fifth interspace, incorporating the camera port. A retractor was placed. The pericardium was opened. The LAD was easily identified in the center of the wound. The mammary artery was prepared for anastomosis. There was however in the distal centimeter a dissection of the vessel, so the mammary was trimmed back. However, this left us with a shorter length and because of this a small segment of saphenous vein was harvested from the left ankle. In an end-to-end fashion the vein graft was anastomosed to the mammary. The LAD was then exposed with a footed retractor. The vessel was entered. A 2 mm intercoronary shunt was placed and the distal anastomosis was then constructed using 7-0 Prolene suture.
Flow probe analysis revealed superb biphasic flow. Echocardiography showed normal left ventricular function. Protamine was administered without any adverse effects. Mammary pedicle was tacked to the heart. A single 32-French chest tube was passed through a lower port and secured to the skin with heavy silk suture. The wound was thoroughly irrigated with excellent hemostasis. The ribs were approximated with paracostal Vicryl. The subcutaneous tissues and muscle were approximated with Vicryl, the skin with Monocryl, and sterile dressings were applied. The patient was taken in stable condition to the open heart recovery room.
FINDINGS: Normal LV function. Good target vessel.