TWilliam2019
Guru
Procedure:
1. Right minithoracotomy with open lung biopsy of the middle lobe and upper lobe
?32505
Specimens:
-Right middle lobe wedge biopsy for pathology and cultures
-Right upper lobe wedge biopsy for pathology
Indication:
female admitted with respiratory distress and tachycardia. She was found to have a lactic acidosis and bilateral pulmonary infiltrates. She has been on the ventilator secondary to acute hypoxic respiratory failure. CT scan revealed diffuse bilateral pulmonary infiltrates, concerning for infectious process, sarcoidosis, or other inflammatory conditions. She presents today for lung biopsy.
Intraoperative findings:
-The upper, middle, and lower lobes appeared pink in color. Palpation revealed some mild thickening, but no nodularity. There may have been slight reduction in compliance, but it did not appear severe.
Procedure in detail:
The patient had her history and physical updated prior to the procedure. She was transferred to the operating suite placed on the operating table. She was already endotracheally intubated. General anesthesia was induced. Monitoring lines and devices were placed by anesthesia. She was then placed in the lateral recumbent position with the right chest facing up. The right chest was 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 minithoracotomy incision was made in the lateral position overlying approximately the fifth intercostal space. The deep dermis and subcutaneous tissues were divided with electrocautery. The latissimus muscle was partially divided. The serratus muscle was also divided. The underlying intercostal muscle was divided with electrocautery and access into the right pleural space was achieved.
The rib retractor was placed with minimal spreading of the ribs. Access over the junction of the oblique and horizontal fissures was achieved. Using reinforced thick tissue stapling loads, a wedge resection of the right middle lobe at the fissure confluence was taken. This specimen was divided, with a portion being submitted for routine, AFB, fungal cultures and the remainder of it being submitted to pathology for evaluation. Next, the upper lobe was grasped near the confluence of the oblique and horizontal fissures. A wedge resection was taken of the upper lobe and this was submitted to pathology for evaluation.
The rib retractor was removed. The soft tissues were injected with half percent Marcaine for local anesthesia. The serratus muscle was reapproximated with 0 Vicryl in a running fashion. The soft tissues were reapproximated with 2-0 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 this portion of the procedure well. The ACS service is planning tracheostomy and PEG tube placement at the completion of the lung biopsy portion. Please see their operative note for official details.
1. Right minithoracotomy with open lung biopsy of the middle lobe and upper lobe
?32505
Specimens:
-Right middle lobe wedge biopsy for pathology and cultures
-Right upper lobe wedge biopsy for pathology
Indication:
female admitted with respiratory distress and tachycardia. She was found to have a lactic acidosis and bilateral pulmonary infiltrates. She has been on the ventilator secondary to acute hypoxic respiratory failure. CT scan revealed diffuse bilateral pulmonary infiltrates, concerning for infectious process, sarcoidosis, or other inflammatory conditions. She presents today for lung biopsy.
Intraoperative findings:
-The upper, middle, and lower lobes appeared pink in color. Palpation revealed some mild thickening, but no nodularity. There may have been slight reduction in compliance, but it did not appear severe.
Procedure in detail:
The patient had her history and physical updated prior to the procedure. She was transferred to the operating suite placed on the operating table. She was already endotracheally intubated. General anesthesia was induced. Monitoring lines and devices were placed by anesthesia. She was then placed in the lateral recumbent position with the right chest facing up. The right chest was 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 minithoracotomy incision was made in the lateral position overlying approximately the fifth intercostal space. The deep dermis and subcutaneous tissues were divided with electrocautery. The latissimus muscle was partially divided. The serratus muscle was also divided. The underlying intercostal muscle was divided with electrocautery and access into the right pleural space was achieved.
The rib retractor was placed with minimal spreading of the ribs. Access over the junction of the oblique and horizontal fissures was achieved. Using reinforced thick tissue stapling loads, a wedge resection of the right middle lobe at the fissure confluence was taken. This specimen was divided, with a portion being submitted for routine, AFB, fungal cultures and the remainder of it being submitted to pathology for evaluation. Next, the upper lobe was grasped near the confluence of the oblique and horizontal fissures. A wedge resection was taken of the upper lobe and this was submitted to pathology for evaluation.
The rib retractor was removed. The soft tissues were injected with half percent Marcaine for local anesthesia. The serratus muscle was reapproximated with 0 Vicryl in a running fashion. The soft tissues were reapproximated with 2-0 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 this portion of the procedure well. The ACS service is planning tracheostomy and PEG tube placement at the completion of the lung biopsy portion. Please see their operative note for official details.