I am struggling with code for the following:
The abdomen was insufflated supraumbilically without incident to 20mmHg of CO2 gas. A standard robotic prostatectomy port configuration was used. The supraumbilical site was entered using an 8 mm robotic trocar. The HD 3D robotic vision laparoscope was inserted. The abdomen was inspected. No bleeding or visceral injury was noted. The remaining ports were inserted under direct vision. A transversus abdominis plane block was accomplished utilized 0.5 % plain Marcaine. Once all of the ports were placed, the insufflation was decreased to 12 mmHg for the remainder of the case. A foley catheter was placed easily and inflated with sterile water.
Next, a vertical cystotomy was performed after the bladder was filled. Four stay sutures (0-Vicryl) were utilized to keep the cystotomy open. On inspection of the bladder, an old blood clot was noted in addition to fresh clot below it. On lifting the prostate up a papillary lesion was noted in one of the cellules that looked like a bladder tumor with adjacent inflammation. This was removed with hot and cold shears. Given the concern for bladder cancer, the decision was made to not proceed with the robotic simple prostatectomy until we got the pathology results back.
Any feedback is welcome! Thank you!
The cystotomy was then closed in 2 layers. First layer was closed with 2-0 V-Loc suture in a running fashion followed by 2-0 V-Loc suture in running fashion. The bladder was then filled and a watertight closure was noted. An 18 Fr foley catheter was then placed to gravity drainage.
All the trocars were removed. No bleeding noted from the port entry sites. All the port sites were then closed using 4-0 Caprosyn in a subcuticular fashion followed by the application of Octyl. Local anesthesia was infused into all port sites.
The abdomen was insufflated supraumbilically without incident to 20mmHg of CO2 gas. A standard robotic prostatectomy port configuration was used. The supraumbilical site was entered using an 8 mm robotic trocar. The HD 3D robotic vision laparoscope was inserted. The abdomen was inspected. No bleeding or visceral injury was noted. The remaining ports were inserted under direct vision. A transversus abdominis plane block was accomplished utilized 0.5 % plain Marcaine. Once all of the ports were placed, the insufflation was decreased to 12 mmHg for the remainder of the case. A foley catheter was placed easily and inflated with sterile water.
Next, a vertical cystotomy was performed after the bladder was filled. Four stay sutures (0-Vicryl) were utilized to keep the cystotomy open. On inspection of the bladder, an old blood clot was noted in addition to fresh clot below it. On lifting the prostate up a papillary lesion was noted in one of the cellules that looked like a bladder tumor with adjacent inflammation. This was removed with hot and cold shears. Given the concern for bladder cancer, the decision was made to not proceed with the robotic simple prostatectomy until we got the pathology results back.
Any feedback is welcome! Thank you!
The cystotomy was then closed in 2 layers. First layer was closed with 2-0 V-Loc suture in a running fashion followed by 2-0 V-Loc suture in running fashion. The bladder was then filled and a watertight closure was noted. An 18 Fr foley catheter was then placed to gravity drainage.
All the trocars were removed. No bleeding noted from the port entry sites. All the port sites were then closed using 4-0 Caprosyn in a subcuticular fashion followed by the application of Octyl. Local anesthesia was infused into all port sites.