tmrang
Contributor
Name Of Procedures: Cervical Mediastinoscopy and lymph node biopsy
Approximately 20 mL of 0.5% Marcaine with epinephrine were injected in the pretracheal fascia. Just above the sternal notch a 2 to 2.5 cm incision was made. The incision was taken through subcutaneous tissue and fascia using electrocautery Bovie. The midline raphae was identified between the strap muscles until the pretracheal fascia was reached. This fascia was incised. The superior mediastinum was reached using gentle blunt finger dissection. Once this was opened, a mediastinoscope was inserted and gently advanced. At the level 4 immediately _____, a large group of lymph nodes were identified. These were resected. They were passed off for cultures as well as pathology. While awaiting the frozen section, the dissection was continued. There was no further evidence of adenopathy until in the subcarinal region was a large group of lymph nodes which were resected. These extended along the right and the left main stem bronchus. Once all the lymphatics were removed, the scope was withdrawn and the biopsy sites were inspected. On the right side just above level 4 at level 3, another group of lymph nodes immediately popped into the view. These were also resected and passed off. The frozen section was consistent with some granulomatous changes with some polarizing material without any evidence of malignancy. Cultures, both from stations 3, 4 and 7, obtained. The remainder was sent for permanent evaluation by pathologist. The wound was irrigated using warm normal saline. There was no evidence of bleeding. Hemostasis was obtained. The subcutaneous tissue and fascia were approximated in multiple layers using Vicryl and Monocryl. Small amount of Dermabond was applied. The patient was awakened in the operating suite and extubated in the operating suite. The patient was transferred to the recovery room in stable condition. All lap pads, instrument and needle counts were correct. There were no complications.
Is this more than a 39400???
Any help is appreciated...
Thank You,
Tonya
Approximately 20 mL of 0.5% Marcaine with epinephrine were injected in the pretracheal fascia. Just above the sternal notch a 2 to 2.5 cm incision was made. The incision was taken through subcutaneous tissue and fascia using electrocautery Bovie. The midline raphae was identified between the strap muscles until the pretracheal fascia was reached. This fascia was incised. The superior mediastinum was reached using gentle blunt finger dissection. Once this was opened, a mediastinoscope was inserted and gently advanced. At the level 4 immediately _____, a large group of lymph nodes were identified. These were resected. They were passed off for cultures as well as pathology. While awaiting the frozen section, the dissection was continued. There was no further evidence of adenopathy until in the subcarinal region was a large group of lymph nodes which were resected. These extended along the right and the left main stem bronchus. Once all the lymphatics were removed, the scope was withdrawn and the biopsy sites were inspected. On the right side just above level 4 at level 3, another group of lymph nodes immediately popped into the view. These were also resected and passed off. The frozen section was consistent with some granulomatous changes with some polarizing material without any evidence of malignancy. Cultures, both from stations 3, 4 and 7, obtained. The remainder was sent for permanent evaluation by pathologist. The wound was irrigated using warm normal saline. There was no evidence of bleeding. Hemostasis was obtained. The subcutaneous tissue and fascia were approximated in multiple layers using Vicryl and Monocryl. Small amount of Dermabond was applied. The patient was awakened in the operating suite and extubated in the operating suite. The patient was transferred to the recovery room in stable condition. All lap pads, instrument and needle counts were correct. There were no complications.
Is this more than a 39400???
Any help is appreciated...
Thank You,
Tonya