TWilliam2019
Guru
Procedure:
1. Thoracotomy, Right
2. Complete pulmonary decortication 32220 RT
3. Right Middle Lobe Wedge Resection 32097
4. Right Lower Lobe Wedge Resection
5. Bilateral Gill Procedure HELP ????
Indications:
is a 68 y.o. male who presented to hospital after a fall with a retained hemothorax the patient underwent a VATS procedure with multiple chest tubes, air leak, and subcutaneous air. Imaging was also concerning for empyema and multiple abscess and we were consulted for surgical recommendations. For these reasons, he was consented and brought to the operating room for the aforementioned procedures.
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 left lateral decubitus position with their right side up. The right 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, a standard thoracotomy incision was then made and dissection was carried down through subcutaneous tissues with electrocautery. Lung isolation was verified with anesthesia. The pleural cavity was then entered a partial rib resection was then performed to aid in retraction.
Next, with the aforementioned assistant the hemithorax was inspected. There was significant pleural rind with lobe fusion to the chest wall in some areas. The lower lobe was carefully freed with blunt dissection. A moderate pleural effusion was present. Some of this fluid was collected in a Luekens trap and passed off the field for culture. A complete decortication began with the lower lobe. The diaphragmatic surface was freed. Some pleural rind was removed and passed off the field as specimen. The major fissure was complete. The middle and upper lobes were fused and were separated carefully. The mediastinal surfaces of the the lung was freed with careful blunt dissection to the level of the apex. Additional pleural rind was removed form all surfaces of the lung to allow for re-expansion. Next, there were two large perforated abscess cavities in both the middle and lower lobe that were causing a bronchopleural fistula. Both of these abscess cavities were resected by performing wedge resections of both the middle and lower lobe back to healthy appearing lung tissue with serial GIA purple covidien staple loads. Next, the chest cavity was then irrigated and the staple lines were checked and confirmed to have no leak. Next, two 32Fr chest tubes were placed, one posteriorly along the diaphragm and one toward the apex. Hemostasis was verified, the ribs were re approximated with number 2 vicryl sutures and the lung was then re-expanded under direct vision. All skin incisions were closed in layers with 0, 2-0 Vicryl, and the skin was closed with staples.
Next, the patient was then positioned supine and he was re prepped and draped in the usual sterile fashion. Next, incisions were then made in both the right and left chest. Next, dissection was carried down through the subcutaneous tissue through the fascia and down onto the pectoralis muscle. Next, hemostasis was verified and two separate negative pressure wound vacs were placed and connected to aid in the release of the subcutaneous air.
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. I was present and active throughout the entire procedure.
1. Thoracotomy, Right
2. Complete pulmonary decortication 32220 RT
3. Right Middle Lobe Wedge Resection 32097
4. Right Lower Lobe Wedge Resection
5. Bilateral Gill Procedure HELP ????
Indications:
is a 68 y.o. male who presented to hospital after a fall with a retained hemothorax the patient underwent a VATS procedure with multiple chest tubes, air leak, and subcutaneous air. Imaging was also concerning for empyema and multiple abscess and we were consulted for surgical recommendations. For these reasons, he was consented and brought to the operating room for the aforementioned procedures.
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 left lateral decubitus position with their right side up. The right 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, a standard thoracotomy incision was then made and dissection was carried down through subcutaneous tissues with electrocautery. Lung isolation was verified with anesthesia. The pleural cavity was then entered a partial rib resection was then performed to aid in retraction.
Next, with the aforementioned assistant the hemithorax was inspected. There was significant pleural rind with lobe fusion to the chest wall in some areas. The lower lobe was carefully freed with blunt dissection. A moderate pleural effusion was present. Some of this fluid was collected in a Luekens trap and passed off the field for culture. A complete decortication began with the lower lobe. The diaphragmatic surface was freed. Some pleural rind was removed and passed off the field as specimen. The major fissure was complete. The middle and upper lobes were fused and were separated carefully. The mediastinal surfaces of the the lung was freed with careful blunt dissection to the level of the apex. Additional pleural rind was removed form all surfaces of the lung to allow for re-expansion. Next, there were two large perforated abscess cavities in both the middle and lower lobe that were causing a bronchopleural fistula. Both of these abscess cavities were resected by performing wedge resections of both the middle and lower lobe back to healthy appearing lung tissue with serial GIA purple covidien staple loads. Next, the chest cavity was then irrigated and the staple lines were checked and confirmed to have no leak. Next, two 32Fr chest tubes were placed, one posteriorly along the diaphragm and one toward the apex. Hemostasis was verified, the ribs were re approximated with number 2 vicryl sutures and the lung was then re-expanded under direct vision. All skin incisions were closed in layers with 0, 2-0 Vicryl, and the skin was closed with staples.
Next, the patient was then positioned supine and he was re prepped and draped in the usual sterile fashion. Next, incisions were then made in both the right and left chest. Next, dissection was carried down through the subcutaneous tissue through the fascia and down onto the pectoralis muscle. Next, hemostasis was verified and two separate negative pressure wound vacs were placed and connected to aid in the release of the subcutaneous air.
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. I was present and active throughout the entire procedure.