TWilliam2019
Guru
Resection of superior anterior mediastinal mass via low collar cervical incision
39000 ? 21899?
Intraoperative findings:
-Soft tissues were somewhat fibrous in consistency
-The anterior mediastinal mass was located anterior to the trachea and posterior to the manubrium. It appeared to be consistent with ectopic thyroid tissue. There was no involvement of adjacent vascular or soft tissue structures. It was not congruent with the thyroid tissue. It was removed in its entirety.
Procedure in detail:
The patient had her history and physical updated prior to the procedure. She was transferred to the operating suite and placed on the operating table where she underwent general anesthesia with endotracheal intubation. Monitoring lines and devices were placed by anesthesia. Shoulder roll was placed. The neck and chest were then prepped and draped in usual sterile fashion using ChloraPrep solution. Timeout was used to confirm patient identity as well as the procedure to be performed. Antibiotics given prior to the incisions.
A small low collar incision was made in a horizontal fashion just above the suprasternal notch using a 10 blade scalpel. The deep dermis and subcutaneous tissues were divided with electrocautery. The platysma was divided horizontally. It was noted that the soft tissues were quite fibrous in nature. Wheat Lander's were then placed for retraction of the soft tissues. The strap muscles were then separated vertically using low energy cautery. This allowed for the isthmus of the thyroid to be identified. The trachea was palpated and dissection was then taken caudally to the level of the suprasternal notch. This allowed for palpation of the mass in question. The mass appeared to be consistent with ectopic thyroid tissue on gross examination.
Using low energy electrocautery, the mass was released from the anterior soft tissues, the soft tissues superiorly as well as along the right strap muscles. 0 silk sutures were placed within the mass to assist with retraction. This allowed elevation of the mass into the neck. More prominent fibrous attachments were involved along its inferior and left lateral poles. These were taken down with the harmonic scalpel. The dissection remained anterior to the trachea throughout the entirety of the procedure. The adjacent vascular structures such as the innominate vein and carotid arteries were not involved with the mediastinal mass. Finally, the mediastinal mass was released from his left lateral soft tissues with the harmonic scalpel. Throughout the procedure, PA was responsible for removing any blood from the field, retracting and improving exposure, as well as responsible for final skin closure.
The mass was then submitted to pathology as a permanent specimen. The dissection bed was checked and found to be hemostatic. The soft tissues were then injected with half percent Marcaine for local anesthesia. The platysma was reapproximated with 2-0 Vicryl in interrupted fashion. The deep dermis was reapproximated with 3-0 Vicryl in a running fashion. The skin was closed with 4-0 Monocryl in a running subcuticular manner. Dermabond was placed over the wound. The patient tolerated the procedure well, was extubated, then transferred to recovery.
39000 ? 21899?
Intraoperative findings:
-Soft tissues were somewhat fibrous in consistency
-The anterior mediastinal mass was located anterior to the trachea and posterior to the manubrium. It appeared to be consistent with ectopic thyroid tissue. There was no involvement of adjacent vascular or soft tissue structures. It was not congruent with the thyroid tissue. It was removed in its entirety.
Procedure in detail:
The patient had her history and physical updated prior to the procedure. She was transferred to the operating suite and placed on the operating table where she underwent general anesthesia with endotracheal intubation. Monitoring lines and devices were placed by anesthesia. Shoulder roll was placed. The neck and chest were then prepped and draped in usual sterile fashion using ChloraPrep solution. Timeout was used to confirm patient identity as well as the procedure to be performed. Antibiotics given prior to the incisions.
A small low collar incision was made in a horizontal fashion just above the suprasternal notch using a 10 blade scalpel. The deep dermis and subcutaneous tissues were divided with electrocautery. The platysma was divided horizontally. It was noted that the soft tissues were quite fibrous in nature. Wheat Lander's were then placed for retraction of the soft tissues. The strap muscles were then separated vertically using low energy cautery. This allowed for the isthmus of the thyroid to be identified. The trachea was palpated and dissection was then taken caudally to the level of the suprasternal notch. This allowed for palpation of the mass in question. The mass appeared to be consistent with ectopic thyroid tissue on gross examination.
Using low energy electrocautery, the mass was released from the anterior soft tissues, the soft tissues superiorly as well as along the right strap muscles. 0 silk sutures were placed within the mass to assist with retraction. This allowed elevation of the mass into the neck. More prominent fibrous attachments were involved along its inferior and left lateral poles. These were taken down with the harmonic scalpel. The dissection remained anterior to the trachea throughout the entirety of the procedure. The adjacent vascular structures such as the innominate vein and carotid arteries were not involved with the mediastinal mass. Finally, the mediastinal mass was released from his left lateral soft tissues with the harmonic scalpel. Throughout the procedure, PA was responsible for removing any blood from the field, retracting and improving exposure, as well as responsible for final skin closure.
The mass was then submitted to pathology as a permanent specimen. The dissection bed was checked and found to be hemostatic. The soft tissues were then injected with half percent Marcaine for local anesthesia. The platysma was reapproximated with 2-0 Vicryl in interrupted fashion. The deep dermis was reapproximated with 3-0 Vicryl in a running fashion. The skin was closed with 4-0 Monocryl in a running subcuticular manner. Dermabond was placed over the wound. The patient tolerated the procedure well, was extubated, then transferred to recovery.