Nita Bhatt
Contributor
OP-NOTE
Pre-Operative DX : metastatic endometrial cancer to the cervical vertebrae,encroaching upon the epidural space.
Post -Operative dx : Same.
Procedure Performed :
1. Cervical and Upper thoracic vertebral Corpectomy,with the placement of cage and Stabilizers and Dorsal Stabilization
2. Resection of upper Thoracic endometrial metastatis invading the posterior Chest wall vertebral processes.
Co-Surgeons.
PROCEDURE :
The patient was taken back to the Operating room, placed in the supine position, after induction of the general double-Lumen endotracheal intubation, the patient had a Foley Catheter placed and arterial line. Her chest was then Prepped and drapped in the usual sterile manner. An incision was made along the anterior border of the Sternocleidomastoioid,down onto the Sternum. The incision waas then deepwened. Self retaining reteractors were then placed in order to affect exposure. The prevetebral space was then identified, and the uppermost portion of the tumour was identified prior to the sternal split. It was felty that the best exposure would be achieved, in the preoperative discussions, with a sternal split and a trap door incision through the second intercostal space. Sternal Saw was taken and the Manubrium was then Split. The saw was then directed towards the second intercostal space. This was open well. The inter mammary vessels were dissected away. The Sternal saw was again used to perform an Osteotomy of the Clavicle at the Junction of the mid and distyal Third of the Clavicle,and an Osteotomy of the ribs 2 and 3. In the Process of elevating the manubrium as mentioned the intermammary vessels ahd been dissected away, but at this point there was a fair amount of bleeding. Direct pressure was used in order to obtain control, and after full dissection was performed it was noted to be in the internal mammary that had been avulsed. This was dissected out proximally and distally, clamped proximally and distally divided and suture ligated with a 4-0 prolene. Once this was done Dr. Khan took over the Operation fully, and performed a Corpectomy and dissected out from the anterior approach. Once this was Completed,but prior to closing , a 28-French Chest tTube was then Placed, just at the Lateral aspect of the inferior Mammary fold under direct Vision, sutured at the Skin level with 0-Silk. The Manubrium was then reapproximated with sternal wires,and then the wound was closed in a layered fashion.
The patient was then re-positioned in the prone position. Her back was prepped and draped in the usual sterile fashion. The neurosurgical team explored the back area. The laminectomy was performed, and the fo;lowingthis,in the intercoastal space was entered and the rib was divided out laterally beyond the tumour at 2 levels, and then the tumour was removed en-bloc and sent to Pathology for analysis. Neurosurgery then placed a posterior rod and closed the wound in a layered Fashion.
Correct me if I understood it wrong, As per my understanding the first Surgeon only did the Osteotomy and the second Surgeon, the Neurosurgeon did the Laminectomy and the tumour removal and instrumentation ?
I think of codes
22220,22226,63081,63276,22840.
Can any one please help to dissect this operative report??
I will greatly appreciate any help.
Thanks.
NB
Pre-Operative DX : metastatic endometrial cancer to the cervical vertebrae,encroaching upon the epidural space.
Post -Operative dx : Same.
Procedure Performed :
1. Cervical and Upper thoracic vertebral Corpectomy,with the placement of cage and Stabilizers and Dorsal Stabilization
2. Resection of upper Thoracic endometrial metastatis invading the posterior Chest wall vertebral processes.
Co-Surgeons.
PROCEDURE :
The patient was taken back to the Operating room, placed in the supine position, after induction of the general double-Lumen endotracheal intubation, the patient had a Foley Catheter placed and arterial line. Her chest was then Prepped and drapped in the usual sterile manner. An incision was made along the anterior border of the Sternocleidomastoioid,down onto the Sternum. The incision waas then deepwened. Self retaining reteractors were then placed in order to affect exposure. The prevetebral space was then identified, and the uppermost portion of the tumour was identified prior to the sternal split. It was felty that the best exposure would be achieved, in the preoperative discussions, with a sternal split and a trap door incision through the second intercostal space. Sternal Saw was taken and the Manubrium was then Split. The saw was then directed towards the second intercostal space. This was open well. The inter mammary vessels were dissected away. The Sternal saw was again used to perform an Osteotomy of the Clavicle at the Junction of the mid and distyal Third of the Clavicle,and an Osteotomy of the ribs 2 and 3. In the Process of elevating the manubrium as mentioned the intermammary vessels ahd been dissected away, but at this point there was a fair amount of bleeding. Direct pressure was used in order to obtain control, and after full dissection was performed it was noted to be in the internal mammary that had been avulsed. This was dissected out proximally and distally, clamped proximally and distally divided and suture ligated with a 4-0 prolene. Once this was done Dr. Khan took over the Operation fully, and performed a Corpectomy and dissected out from the anterior approach. Once this was Completed,but prior to closing , a 28-French Chest tTube was then Placed, just at the Lateral aspect of the inferior Mammary fold under direct Vision, sutured at the Skin level with 0-Silk. The Manubrium was then reapproximated with sternal wires,and then the wound was closed in a layered fashion.
The patient was then re-positioned in the prone position. Her back was prepped and draped in the usual sterile fashion. The neurosurgical team explored the back area. The laminectomy was performed, and the fo;lowingthis,in the intercoastal space was entered and the rib was divided out laterally beyond the tumour at 2 levels, and then the tumour was removed en-bloc and sent to Pathology for analysis. Neurosurgery then placed a posterior rod and closed the wound in a layered Fashion.
Correct me if I understood it wrong, As per my understanding the first Surgeon only did the Osteotomy and the second Surgeon, the Neurosurgeon did the Laminectomy and the tumour removal and instrumentation ?
I think of codes
22220,22226,63081,63276,22840.
Can any one please help to dissect this operative report??
I will greatly appreciate any help.
Thanks.
NB