sandy06
Networker
PREOPERATIVE DIAGNOSIS:
Osteomyelitis of the spine with unstable spine.
OPERATION PERFORMED:
A two-part procedure:
1. The first part is placement of a right subclavian triple-lumen
catheter.
2. The second part of the procedure was the thoracic surgical portion
of procedure, which consisted of a left lateral thoracotomy with
exposure for a T9-T10 two-level corpectomy with instrumentation.
3. A seventh rib resection.
4. Intracostal nerve blocks.
OPERATING SURGEONS:
Dr. A
FIRST ASSISTANT:
Neurosurgeon, who performed the spinal portion of the case, Dr. B
DESCRIPTION OF THE OPERATIVE PROCEDURE:
After the patient had received preoperative antibiotics, the
patient's right anterior chest was prepped and draped in the usual
sterile fashion. A right triple-lumen CVP line was placed for IV
access for the case in the usual fashion and it was appropriately
secured utilizing 2-0 silk sutures. Thereafter, after the appropriate
spinal monitoring was placed, the patient was positioned in a left
posterolateral thoracotomy position. Under fluoroscopy, the area of
interest was identified and marked. Thereafter, after an appropriate
surgical time-out was taken, a left posterolateral thoracotomy was
carried out along the seventh intercostal space. Dissection was
carried down to the latissimus dorsi posteriorly. A serratus anterior
was divided anteriorly, thereafter, in the eighth intercostal space,
a thoracotomy incision was carried out, after the lung was deflated.
The seventh rib was resected so as to add for adequate exposure.
Thereafter, the inferior pulmonary ligament was taken down. The lung
was mobilized anteriorly. Thereafter, the posterior mediastinal
pleura was taken down utilizing electrocautery. There were a few
intercostal feeders, which were divided between doubly placed
medium-sized clips. The larger, most inferior radicular branch was
preserved. Thereafter, the aorta was tacked and mobilized anteriorly,
utilizing interrupted 4-0 Prolene sutures anchoring the edge of the
posterior mediastinal pleura anteriorly, so as lifting the aorta off
the spine. The anterior aspect of the spine was cleared, this
resulted in adequate exposure for Dr. Lasner to perform his T9-T10
corpectomy with instrumentation and placement of a cage and bone
grafting. Upon completion of the thoracic surgical portion of the
case, the chest was irrigated utilizing a warm saline. Meticulous
hemostasis was obtained, intercostal nerve blocks were performed
utilizing injectable 0.25-percent Marcaine. Thereafter, the chest was
closed utilizing number-1 Vicryl pericostal sutures in a
figure-of-eight fashion. The muscle and fascia layers were closed
utilizing running 0-Vicryl suture in anatomical layers. The skin was
closed utilizing metallic clips. Prior to closure a number-32 chest
tube was placed and brought out through a separate stab wound in the
lateral chest wall, it was secured utilizing 0-Ethibond suture. The
patient was positioned in a supine position at the completion of the
procedure. Portable chest x-ray was obtained, which was revealed the
lung to be completely expanded and chest tube in good position.
Can someone please give me an insight on this Opt Report, I realy don't know where to begin on this one.
Osteomyelitis of the spine with unstable spine.
OPERATION PERFORMED:
A two-part procedure:
1. The first part is placement of a right subclavian triple-lumen
catheter.
2. The second part of the procedure was the thoracic surgical portion
of procedure, which consisted of a left lateral thoracotomy with
exposure for a T9-T10 two-level corpectomy with instrumentation.
3. A seventh rib resection.
4. Intracostal nerve blocks.
OPERATING SURGEONS:
Dr. A
FIRST ASSISTANT:
Neurosurgeon, who performed the spinal portion of the case, Dr. B
DESCRIPTION OF THE OPERATIVE PROCEDURE:
After the patient had received preoperative antibiotics, the
patient's right anterior chest was prepped and draped in the usual
sterile fashion. A right triple-lumen CVP line was placed for IV
access for the case in the usual fashion and it was appropriately
secured utilizing 2-0 silk sutures. Thereafter, after the appropriate
spinal monitoring was placed, the patient was positioned in a left
posterolateral thoracotomy position. Under fluoroscopy, the area of
interest was identified and marked. Thereafter, after an appropriate
surgical time-out was taken, a left posterolateral thoracotomy was
carried out along the seventh intercostal space. Dissection was
carried down to the latissimus dorsi posteriorly. A serratus anterior
was divided anteriorly, thereafter, in the eighth intercostal space,
a thoracotomy incision was carried out, after the lung was deflated.
The seventh rib was resected so as to add for adequate exposure.
Thereafter, the inferior pulmonary ligament was taken down. The lung
was mobilized anteriorly. Thereafter, the posterior mediastinal
pleura was taken down utilizing electrocautery. There were a few
intercostal feeders, which were divided between doubly placed
medium-sized clips. The larger, most inferior radicular branch was
preserved. Thereafter, the aorta was tacked and mobilized anteriorly,
utilizing interrupted 4-0 Prolene sutures anchoring the edge of the
posterior mediastinal pleura anteriorly, so as lifting the aorta off
the spine. The anterior aspect of the spine was cleared, this
resulted in adequate exposure for Dr. Lasner to perform his T9-T10
corpectomy with instrumentation and placement of a cage and bone
grafting. Upon completion of the thoracic surgical portion of the
case, the chest was irrigated utilizing a warm saline. Meticulous
hemostasis was obtained, intercostal nerve blocks were performed
utilizing injectable 0.25-percent Marcaine. Thereafter, the chest was
closed utilizing number-1 Vicryl pericostal sutures in a
figure-of-eight fashion. The muscle and fascia layers were closed
utilizing running 0-Vicryl suture in anatomical layers. The skin was
closed utilizing metallic clips. Prior to closure a number-32 chest
tube was placed and brought out through a separate stab wound in the
lateral chest wall, it was secured utilizing 0-Ethibond suture. The
patient was positioned in a supine position at the completion of the
procedure. Portable chest x-ray was obtained, which was revealed the
lung to be completely expanded and chest tube in good position.
Can someone please give me an insight on this Opt Report, I realy don't know where to begin on this one.