plazauro
New
I am going to code the first procedure as 52649-52 because of the equipment malfunction but I'm not sure on the removal of prostate tissue through minicystotomy... thoughts?
*
*
*
PREOPERATIVE DIAGNOSIS:
Benign prostatic hypertrophy/left urinary obstruction.
*
POSTOPERATIVE DIAGNOSIS:
Benign prostatic hypertrophy/left urinary obstruction.
*
PROCEDURE PERFORMED:
1. Laser enucleation of the prostate.
2. Open cystotomy with prostate removal.
*
ANESTHESIA:
GETA.
*
ESTIMATED BLOOD LOSS:
Minimal.
*
FINDINGS:
Enucleation of large ball valve in the middle lobe and lateral lobes. Left lobe was vaporized. At the time of morcellation, the morcellator malfunctioned and there was no replacement piece. He required open removal of prostate tissue through minicystotomy as the most time-effective choice for removal.
*
DRAINS:
A 22-French 3-way Foley catheter.
*
COMPLICATIONS:
None.
*
DISPOSITION:
Patient stable to postoperative recovery.
*
INDICATION FOR PROCEDURE:
This is a 71-year-old gentleman with a history of hypocontractile bladder and BPH/LUTS presenting for laser enucleation of the prostate. He has been made aware of the risks, benefits and complications prior to this procedure prior to undergoing, including but not limited to, bleeding, infection, retention, retained pieces, clot retention, urethral injury, bladder perforation to which he understood.
*
OPERATIVE SUMMARY:
The patient was taken to the operating room and placed in the supine position. General anesthesia was induced by endotracheal intubation. A surgical time-out was performed. The patient was placed in the lithotomy position. Genitals were prepped and draped in a normal sterile manner. The bladder was entered with a laser endoscope. He had a large median lobe that had entered significant intravesical portion. He has large lateral lobes as well. Ureteral orifices were set back and not located on the prostate within the bladder. An incision was made in the lateral sulci of the median lobe down to capsule. The median lobe was then enucleated. The right lobe was then enucleated up to the 12 o'clock position. The left lobe was vaporized. The morcellator was put in place. I started to morcellate 1 piece and then malfunctioned. We attempted with a 2nd morcellator piece; however, the morcellator blade had no replacement. There would have been a 30-45 minute wait for the blade to get to the operating room. Given the size of his lobes and the anesthesia time of 2 hours at the time of this occurrence, it was elected to remove the prostate through a minicystotomy. The scope was removed and the catheter was placed in the bladder and kept on CBI with normal saline. The abdomen was shaved, prepped and draped in a normal sterile manner. A midline incision was planned after 1% lidocaine in 0.5% Marcaine plain solution. The skin was incised. Subcutaneous tissue was divided with electrocautery. The anterior rectus fascia was identified and then divided sharply. The pyramidalis dialysis was opened within its midline. The retroperitoneal space of Retzius was then opened sharply. The bladder was filled completely. A 5 cm incision into the bladder was obtained after stay sutures had been placed. The 3 pieces of prostate were removed. There were no residual pieces. He had a very thick trabeculated bladder identified at the incision. The bladder was then closed in 2 layers with a running 3-0 chromic suture as a muscular mucosal layer and a 3-0 Vicryl as a seromuscular layer. The bladder was filled and there was no leak identified. The rectus fascia was closed with an 0 Vicryl suture. Subcutaneous tissue was closed with 3-0 Vicryl suture. The skin was closed with staples. The patient tolerated the procedure well, was extubated in a stable manner and transferred to the PACU on CBI.
*
*
*
*
PREOPERATIVE DIAGNOSIS:
Benign prostatic hypertrophy/left urinary obstruction.
*
POSTOPERATIVE DIAGNOSIS:
Benign prostatic hypertrophy/left urinary obstruction.
*
PROCEDURE PERFORMED:
1. Laser enucleation of the prostate.
2. Open cystotomy with prostate removal.
*
ANESTHESIA:
GETA.
*
ESTIMATED BLOOD LOSS:
Minimal.
*
FINDINGS:
Enucleation of large ball valve in the middle lobe and lateral lobes. Left lobe was vaporized. At the time of morcellation, the morcellator malfunctioned and there was no replacement piece. He required open removal of prostate tissue through minicystotomy as the most time-effective choice for removal.
*
DRAINS:
A 22-French 3-way Foley catheter.
*
COMPLICATIONS:
None.
*
DISPOSITION:
Patient stable to postoperative recovery.
*
INDICATION FOR PROCEDURE:
This is a 71-year-old gentleman with a history of hypocontractile bladder and BPH/LUTS presenting for laser enucleation of the prostate. He has been made aware of the risks, benefits and complications prior to this procedure prior to undergoing, including but not limited to, bleeding, infection, retention, retained pieces, clot retention, urethral injury, bladder perforation to which he understood.
*
OPERATIVE SUMMARY:
The patient was taken to the operating room and placed in the supine position. General anesthesia was induced by endotracheal intubation. A surgical time-out was performed. The patient was placed in the lithotomy position. Genitals were prepped and draped in a normal sterile manner. The bladder was entered with a laser endoscope. He had a large median lobe that had entered significant intravesical portion. He has large lateral lobes as well. Ureteral orifices were set back and not located on the prostate within the bladder. An incision was made in the lateral sulci of the median lobe down to capsule. The median lobe was then enucleated. The right lobe was then enucleated up to the 12 o'clock position. The left lobe was vaporized. The morcellator was put in place. I started to morcellate 1 piece and then malfunctioned. We attempted with a 2nd morcellator piece; however, the morcellator blade had no replacement. There would have been a 30-45 minute wait for the blade to get to the operating room. Given the size of his lobes and the anesthesia time of 2 hours at the time of this occurrence, it was elected to remove the prostate through a minicystotomy. The scope was removed and the catheter was placed in the bladder and kept on CBI with normal saline. The abdomen was shaved, prepped and draped in a normal sterile manner. A midline incision was planned after 1% lidocaine in 0.5% Marcaine plain solution. The skin was incised. Subcutaneous tissue was divided with electrocautery. The anterior rectus fascia was identified and then divided sharply. The pyramidalis dialysis was opened within its midline. The retroperitoneal space of Retzius was then opened sharply. The bladder was filled completely. A 5 cm incision into the bladder was obtained after stay sutures had been placed. The 3 pieces of prostate were removed. There were no residual pieces. He had a very thick trabeculated bladder identified at the incision. The bladder was then closed in 2 layers with a running 3-0 chromic suture as a muscular mucosal layer and a 3-0 Vicryl as a seromuscular layer. The bladder was filled and there was no leak identified. The rectus fascia was closed with an 0 Vicryl suture. Subcutaneous tissue was closed with 3-0 Vicryl suture. The skin was closed with staples. The patient tolerated the procedure well, was extubated in a stable manner and transferred to the PACU on CBI.
*