Is anyone able to help with the codes for this?
A horizontal scrotal incision was made with a #15 blade. Subcutaneous tissue and dartos fascia was dissected using Bovie. Hemostasis was achieved as we proceeded where needed. The tunica vaginalis was opened anteriorly and the testicle/scrotal contents were delivered out of the incision. Visual inspection showed unremarkable testicle and epididymis. The nodule of interest on exam appeared to be part of the vas, likely consequence of his vasectomy a few years ago possibly sperm granuloma. Due to prior procedure in the area (vasectomy) the nodule and vas distally were intimately adherent to the epididymis and spermatic cord structures. Careful lysis of adhesions and dissection was done to separate the vas with nodule away from the important spermatic cord structures and vasculature.
Combination of blunt and Bovie dissection were used to free the vas without nodule off of the spermatic cord structures and epididymis. Small size LigaSure was also used for safe dissection were necessary. Once the vas was completely isolated from surrounding structures safely, the vasa was suture-ligated with 3-0 Vicryl tie x 2 proximally and transected with the LigaSure and similarly it was tied distal to the nodule close to the epididymis tail and transected with LigaSure. Specimen was sent to pathology. The field was inspected and there was no concerning bleeding. The field was irrigated thoroughly multiple times and inspected again. Good hemostasis was noted. Spermatic cord structures appeared uninjured. The epididymis and right testicle appeared uninjured. No concerns within the surgical field. The appendix testis was cauterized and transected. The testicle was delivered back into the scrotum and the normal anatomic orientation.
The dartos layer was then closed with a 2-0 Vicryl suture in a running fashion. 0.25% Marcaine was used for infiltration of the subcutaneous tissue to help with pain control. The skin was then closed with a running 2-0 chromic suture along with a few simple interrupted stitches for reinforcement.
Thank you for any help you may be able to give.
A horizontal scrotal incision was made with a #15 blade. Subcutaneous tissue and dartos fascia was dissected using Bovie. Hemostasis was achieved as we proceeded where needed. The tunica vaginalis was opened anteriorly and the testicle/scrotal contents were delivered out of the incision. Visual inspection showed unremarkable testicle and epididymis. The nodule of interest on exam appeared to be part of the vas, likely consequence of his vasectomy a few years ago possibly sperm granuloma. Due to prior procedure in the area (vasectomy) the nodule and vas distally were intimately adherent to the epididymis and spermatic cord structures. Careful lysis of adhesions and dissection was done to separate the vas with nodule away from the important spermatic cord structures and vasculature.
Combination of blunt and Bovie dissection were used to free the vas without nodule off of the spermatic cord structures and epididymis. Small size LigaSure was also used for safe dissection were necessary. Once the vas was completely isolated from surrounding structures safely, the vasa was suture-ligated with 3-0 Vicryl tie x 2 proximally and transected with the LigaSure and similarly it was tied distal to the nodule close to the epididymis tail and transected with LigaSure. Specimen was sent to pathology. The field was inspected and there was no concerning bleeding. The field was irrigated thoroughly multiple times and inspected again. Good hemostasis was noted. Spermatic cord structures appeared uninjured. The epididymis and right testicle appeared uninjured. No concerns within the surgical field. The appendix testis was cauterized and transected. The testicle was delivered back into the scrotum and the normal anatomic orientation.
The dartos layer was then closed with a 2-0 Vicryl suture in a running fashion. 0.25% Marcaine was used for infiltration of the subcutaneous tissue to help with pain control. The skin was then closed with a running 2-0 chromic suture along with a few simple interrupted stitches for reinforcement.
Thank you for any help you may be able to give.