TWilliam2019
Guru
ARE THESE CORRECT?
32650
32666
Procedure:
1. Video thoracoscopy, Left
2. Mechanical and chemical (talc) pleurodesis, Left
3. Wedge resection, Left upper lobe (lung)
*
Indications:
Mrs. is a 47 y/o woman who presented with a recurrent left pneumothorax. For these reasons, she was consented and brought to the operating room for the aforementioned procedures.
Wound Classification:
Clean-contaminated.
*
Findings:
Left apical bleb disease. This was removed and taken for specimen. Mechanical and talc pleurodesis proceeded without incident.
*
Specimens:
Left upper lobe wedge resection
*
Procedure Details:*
The patient had their history and physical updated prior to the procedure. They were then transferred to the operating suite and placed on the operating table where general anesthesia with dual-lumen endotracheal intubation was affected. Monitoring lines were placed by anesthesia. The patient was then repositioned in the right lateral decubitus position with their left side up. The patient's previously placed chest tube was removed. The left chest was then prepped and draped in the usual sterile fashion. A surgical time-out was then performed to confirm patient identity, laterality, as well as the surgery to be performed.
*
Next, an approximately 1cm skin incision was made overlying the 8th interspace in the anterior axillary line. Dissection was carried down through subcutaneous tissues with electrocautery. Lung isolation was verified with anesthesia. The pleural cavity was then entered. Additional working ports were placed posteriorly in the 10th interspace anteriorly in the 5th interspace, all under direct vision. The lung was reflected anteriorly, inferiorly and medially to expose the apex. The surface of the lung was systematically inspected. The fissures were complete. There was identifiable bleb diease of the apical surface of the lung. The decision was made to proceed with a wedge resection of the apex. The most prominent bleb was identified. This was then removed using two sequential firings of an endo-GIA linear cutting stapler reinforced purple tri-stapler load. This was removed from the patient and passed off the field as a specimen.
*
Next, the apex of the left chest was mechanically scored with an electrocautery scuff pad. The parietal pleura was adequately denuded to expose the upper rib surfaces and intercostal muscles circumferentially around the apex, with care taken to avoid injury to the subclavian neurovascular bundle, and phenic nerve, which were all identified and preserved. 3gm of aerosolized talc powder was instilled into the pleural space to even coat the parietal pleura of the left hemithorax and lung surface.
*
Next, two 32Fr chest tubes were placed, one anteriorly and to the apex, and one posteriorly along the diaphragm. Hemostasis was verified. The lung was then reexpanded under direct vision. All skin incisions were closed in layers with 0 and 2-0 Vicryl. 4-0 Monocryl in a running subcuticular manner was used to close the skin. Dermabond was placed over the wounds. At this stage, the procedure was discontinued. The patient was delivered from anesthesia, extubated, and transferred to the postanesthesia recovery unit in stable condition having tolerated the procedure well.
32650
32666
Procedure:
1. Video thoracoscopy, Left
2. Mechanical and chemical (talc) pleurodesis, Left
3. Wedge resection, Left upper lobe (lung)
*
Indications:
Mrs. is a 47 y/o woman who presented with a recurrent left pneumothorax. For these reasons, she was consented and brought to the operating room for the aforementioned procedures.
Wound Classification:
Clean-contaminated.
*
Findings:
Left apical bleb disease. This was removed and taken for specimen. Mechanical and talc pleurodesis proceeded without incident.
*
Specimens:
Left upper lobe wedge resection
*
Procedure Details:*
The patient had their history and physical updated prior to the procedure. They were then transferred to the operating suite and placed on the operating table where general anesthesia with dual-lumen endotracheal intubation was affected. Monitoring lines were placed by anesthesia. The patient was then repositioned in the right lateral decubitus position with their left side up. The patient's previously placed chest tube was removed. The left chest was then prepped and draped in the usual sterile fashion. A surgical time-out was then performed to confirm patient identity, laterality, as well as the surgery to be performed.
*
Next, an approximately 1cm skin incision was made overlying the 8th interspace in the anterior axillary line. Dissection was carried down through subcutaneous tissues with electrocautery. Lung isolation was verified with anesthesia. The pleural cavity was then entered. Additional working ports were placed posteriorly in the 10th interspace anteriorly in the 5th interspace, all under direct vision. The lung was reflected anteriorly, inferiorly and medially to expose the apex. The surface of the lung was systematically inspected. The fissures were complete. There was identifiable bleb diease of the apical surface of the lung. The decision was made to proceed with a wedge resection of the apex. The most prominent bleb was identified. This was then removed using two sequential firings of an endo-GIA linear cutting stapler reinforced purple tri-stapler load. This was removed from the patient and passed off the field as a specimen.
*
Next, the apex of the left chest was mechanically scored with an electrocautery scuff pad. The parietal pleura was adequately denuded to expose the upper rib surfaces and intercostal muscles circumferentially around the apex, with care taken to avoid injury to the subclavian neurovascular bundle, and phenic nerve, which were all identified and preserved. 3gm of aerosolized talc powder was instilled into the pleural space to even coat the parietal pleura of the left hemithorax and lung surface.
*
Next, two 32Fr chest tubes were placed, one anteriorly and to the apex, and one posteriorly along the diaphragm. Hemostasis was verified. The lung was then reexpanded under direct vision. All skin incisions were closed in layers with 0 and 2-0 Vicryl. 4-0 Monocryl in a running subcuticular manner was used to close the skin. Dermabond was placed over the wounds. At this stage, the procedure was discontinued. The patient was delivered from anesthesia, extubated, and transferred to the postanesthesia recovery unit in stable condition having tolerated the procedure well.