sandy06
Networker
OPERATION PERFORMED:
1. Fiberoptic bronchoscopy with bronchoalveolar lavage of the right
lower lobe. An micro brushings of the right lower lobe.
2. Right video-assisted thoracoscopy with thoracoscopic wedge
resection biopsy x3 (lateral segment right middle lobe, posterior
segment right upper lobe and basilar segment right lower lobe).
3. Intercostal nerve blocks with placement of On-Q pain management
system.
SURGEON:
Dr. A
FIRST ASSISTANT:
Dr. B.
PROCEDURE:
The patient was brought to the operating room after having
appropriate monitoring lines placed by anesthesia. Patient received
preoperative antibiotics. The patient underwent endotracheal
intubation. Thereafter, an appropriate surgical time-out was taken.
Thereafter, an Olympus digital diagnostic bronchoscope was brought
onto the field. The bronchoscopy revealed no evidence of any
endobronchial lesions. The right lower lobe was targeted as the area
of interest. Thereafter diagnostic microscopic brushings were
performed. These were sent off to micro for appropriate cultures.
Subsequently a bronchoalveolar lavage was performed. The specimen was
also collected and was split in two for cytologic as well as culture
analysis. Thereafter, the patient had a endobronchial block placed.
The patient was then subsequently positioned in the right
posterolateral thoracotomy position. The patient prepped and draped
in usual sterile fashion. Thereafter, a 1.5 cm skin incision was made
in the ninth intercostal space in the midaxillary line. Dissection
was carried down through subcutaneous tissue. The right lung was
deflated. The pleural space is entered under direct vision utilizing
electrocautery. Thereafter, a 12 mm trocar port was introduced to the
chest and was hooked to low-flow carbon dioxide insufflation.
Thereafter, a 10 mm x 30 degree Olympus camera was advanced into the
chest. Upon entering the chest, the findings were that of grossly
abnormal appearing lung parenchyma. Under direct vision with the
camera, two working port incisions were created, one in the fifth
intercostal space posteriorly and one in the fourth intercostal space
anteriorly. These 12 mm trocar ports were placed under direct vision.
Thereafter, in a serial fashion three wedge resection biopsies were
carried out. These were performed in the same technique. Under direct
vision with the camera, the wedge resection biopsies were completed
utilizing multiple firings of a Covidien 60 mm purple load linear
cutting Tri-stapling device. The specimens were removed from the
chest through EndoCatch bags. One specimen was divided in half and
half was sent off for tissue culture and half was sent out to
pathology. Frozen section analysis revealed abnormal lung tissue
containing granulomatous disease. Thereafter intercostal nerve blocks
were performed from the third to eleventh interspaces utilizing
injectable 0.25 percent Marcaine. An On-Q pain management system was
brought onto the field. The On-Q catheters were delivered utilizing
the percutaneous delivery system and were placed in the posterior
paraspinal space, one superiorly and one inferiorly. Thereafter, the
camera was removed from the ninth, the incision. The chest tube was
placed through the ninth incision. Ventilation was then resumed, the
camera was removed. The ports were removed. The port incisions were
then closed utilizing interrupted 0 Vicryl suture on the muscle and
fascia layers and 4-0 Monocryl was used to close the skin. Skin
closure reinforced utilizing Dermabond. Sterile dressings were
applied. The chest tube was hooked to Pleur-Evac drainage. The
patient tolerated the procedure well. The patient was positioned back
in the supine position. Portable chest x-ray was obtained, which
revealed the lung to be completely expanded and the chest tube in
good position. The patient was extubated in the operating room. The
patient was transferred to recovery room in stable, but critical,
condition.
Can some one please give and insight on this Opt Report, I'm very
I appreciate any help.
Thanks
1. Fiberoptic bronchoscopy with bronchoalveolar lavage of the right
lower lobe. An micro brushings of the right lower lobe.
2. Right video-assisted thoracoscopy with thoracoscopic wedge
resection biopsy x3 (lateral segment right middle lobe, posterior
segment right upper lobe and basilar segment right lower lobe).
3. Intercostal nerve blocks with placement of On-Q pain management
system.
SURGEON:
Dr. A
FIRST ASSISTANT:
Dr. B.
PROCEDURE:
The patient was brought to the operating room after having
appropriate monitoring lines placed by anesthesia. Patient received
preoperative antibiotics. The patient underwent endotracheal
intubation. Thereafter, an appropriate surgical time-out was taken.
Thereafter, an Olympus digital diagnostic bronchoscope was brought
onto the field. The bronchoscopy revealed no evidence of any
endobronchial lesions. The right lower lobe was targeted as the area
of interest. Thereafter diagnostic microscopic brushings were
performed. These were sent off to micro for appropriate cultures.
Subsequently a bronchoalveolar lavage was performed. The specimen was
also collected and was split in two for cytologic as well as culture
analysis. Thereafter, the patient had a endobronchial block placed.
The patient was then subsequently positioned in the right
posterolateral thoracotomy position. The patient prepped and draped
in usual sterile fashion. Thereafter, a 1.5 cm skin incision was made
in the ninth intercostal space in the midaxillary line. Dissection
was carried down through subcutaneous tissue. The right lung was
deflated. The pleural space is entered under direct vision utilizing
electrocautery. Thereafter, a 12 mm trocar port was introduced to the
chest and was hooked to low-flow carbon dioxide insufflation.
Thereafter, a 10 mm x 30 degree Olympus camera was advanced into the
chest. Upon entering the chest, the findings were that of grossly
abnormal appearing lung parenchyma. Under direct vision with the
camera, two working port incisions were created, one in the fifth
intercostal space posteriorly and one in the fourth intercostal space
anteriorly. These 12 mm trocar ports were placed under direct vision.
Thereafter, in a serial fashion three wedge resection biopsies were
carried out. These were performed in the same technique. Under direct
vision with the camera, the wedge resection biopsies were completed
utilizing multiple firings of a Covidien 60 mm purple load linear
cutting Tri-stapling device. The specimens were removed from the
chest through EndoCatch bags. One specimen was divided in half and
half was sent off for tissue culture and half was sent out to
pathology. Frozen section analysis revealed abnormal lung tissue
containing granulomatous disease. Thereafter intercostal nerve blocks
were performed from the third to eleventh interspaces utilizing
injectable 0.25 percent Marcaine. An On-Q pain management system was
brought onto the field. The On-Q catheters were delivered utilizing
the percutaneous delivery system and were placed in the posterior
paraspinal space, one superiorly and one inferiorly. Thereafter, the
camera was removed from the ninth, the incision. The chest tube was
placed through the ninth incision. Ventilation was then resumed, the
camera was removed. The ports were removed. The port incisions were
then closed utilizing interrupted 0 Vicryl suture on the muscle and
fascia layers and 4-0 Monocryl was used to close the skin. Skin
closure reinforced utilizing Dermabond. Sterile dressings were
applied. The chest tube was hooked to Pleur-Evac drainage. The
patient tolerated the procedure well. The patient was positioned back
in the supine position. Portable chest x-ray was obtained, which
revealed the lung to be completely expanded and the chest tube in
good position. The patient was extubated in the operating room. The
patient was transferred to recovery room in stable, but critical,
condition.
Can some one please give and insight on this Opt Report, I'm very
I appreciate any help.
Thanks
Last edited: