TWilliam2019
Guru
Is 32606 correct?
procedure:
#1 left VATS with wide local mediastinal drainage
#2 evacuation of left pleural effusion
#3 multilevel intercostal nerve block
Specimens:
- Left pleural effusion for cultures
estimated blood loss: 10 mL's
blood replaced: None
drains: 24 French Silastic chest tube along the mediastinum, 28 French straight chest tube in the left pleural cavity
implants: None
complications: None
condition at completion of procedure: Stable
Intraoperative findings:
- Small left pleural effusion, turbid in nature, early rind formation on the posterior aspect of the left lower lobe. Minimal and overall quality.
- No distinct abscess identified within the periesophageal mediastinal tissues. Serous fluid drained from the mediastinal tissues
Procedure in detail:
The patient had his history and physical updated prior to the procedure. He was transferred to the operating suite and placed on the operating table where he underwent general anesthesia with endotracheal intubation. Monitoring lines were placed by anesthesia. The airway was secured with a double-lumen endotracheal tube. The patient was placed in the lateral recumbent position with the left chest facing up. Left chest was prepped and draped with ChloraPrep solution. Timeout was used confirm patient identity as well as the procedure to be performed. Antibiotics given prior the incisions.
A 5 mm incision was made at the posterior axillary line, roughly the seventh or eighth intercostal space. The soft tissues were divided and access into the left pleural cavity was achieved. A 10 mm incision was made more anteriorly near the cardiophrenic angle at the sixth intercostal space. The lung was retracted. A turbid left pleural effusion was identified. This was removed and collected, was then submitted for routine and fungal cultures.
A 5 mm incision was then placed posteriorly. resident use electrocautery hook to open the mediastinal pleura extending from the inferior pulmonary ligament superiorly to the aortic arch. The esophagus was identified. Near the carina, a level VII lymph node was identified that had heavy calcification, likely secondary to granulomatous disease. Throughout the wide local mediastinal drainage, with each incremental opening, there would be serous fluid drained from the mediastinum. After wide local mediastinal drainage was complete, the esophagus was inspected with no obvious evidence of paraesophageal abscess. The left pleural cavity was then copiously irrigated with normal saline and suctioned out. During the procedure, Mr. R was responsible for maneuvering the VATS camera and securing the chest tubes.
A multilevel intercostal nerve block was performed with half percent Marcaine with epinephrine for regional anesthesia. The soft tissues were also injected. A 24 French Silastic chest tube was placed along the posterior mediastinum and the esophagus. A 28 French straight chest tube was placed at the apex. The lungs were ventilated before reexpansion. The soft tissues reapproximated with 2-0 Vicryl. The skin was closed 4-0 Monocryl in a running subcuticular manner. Dermabond was placed over the wound. The patient tolerated procedure well, was extubated, then transferred recovery.
procedure:
#1 left VATS with wide local mediastinal drainage
#2 evacuation of left pleural effusion
#3 multilevel intercostal nerve block
Specimens:
- Left pleural effusion for cultures
estimated blood loss: 10 mL's
blood replaced: None
drains: 24 French Silastic chest tube along the mediastinum, 28 French straight chest tube in the left pleural cavity
implants: None
complications: None
condition at completion of procedure: Stable
Intraoperative findings:
- Small left pleural effusion, turbid in nature, early rind formation on the posterior aspect of the left lower lobe. Minimal and overall quality.
- No distinct abscess identified within the periesophageal mediastinal tissues. Serous fluid drained from the mediastinal tissues
Procedure in detail:
The patient had his history and physical updated prior to the procedure. He was transferred to the operating suite and placed on the operating table where he underwent general anesthesia with endotracheal intubation. Monitoring lines were placed by anesthesia. The airway was secured with a double-lumen endotracheal tube. The patient was placed in the lateral recumbent position with the left chest facing up. Left chest was prepped and draped with ChloraPrep solution. Timeout was used confirm patient identity as well as the procedure to be performed. Antibiotics given prior the incisions.
A 5 mm incision was made at the posterior axillary line, roughly the seventh or eighth intercostal space. The soft tissues were divided and access into the left pleural cavity was achieved. A 10 mm incision was made more anteriorly near the cardiophrenic angle at the sixth intercostal space. The lung was retracted. A turbid left pleural effusion was identified. This was removed and collected, was then submitted for routine and fungal cultures.
A 5 mm incision was then placed posteriorly. resident use electrocautery hook to open the mediastinal pleura extending from the inferior pulmonary ligament superiorly to the aortic arch. The esophagus was identified. Near the carina, a level VII lymph node was identified that had heavy calcification, likely secondary to granulomatous disease. Throughout the wide local mediastinal drainage, with each incremental opening, there would be serous fluid drained from the mediastinum. After wide local mediastinal drainage was complete, the esophagus was inspected with no obvious evidence of paraesophageal abscess. The left pleural cavity was then copiously irrigated with normal saline and suctioned out. During the procedure, Mr. R was responsible for maneuvering the VATS camera and securing the chest tubes.
A multilevel intercostal nerve block was performed with half percent Marcaine with epinephrine for regional anesthesia. The soft tissues were also injected. A 24 French Silastic chest tube was placed along the posterior mediastinum and the esophagus. A 28 French straight chest tube was placed at the apex. The lungs were ventilated before reexpansion. The soft tissues reapproximated with 2-0 Vicryl. The skin was closed 4-0 Monocryl in a running subcuticular manner. Dermabond was placed over the wound. The patient tolerated procedure well, was extubated, then transferred recovery.