lcathey@smsc.org
Networker
- Messages
- 50
- Best answers
- 0
Please code this note . I think it is 60220, but the hospital is using 60210. Thanks!!!
PREOPERATIVE DIAGNOSIS:
Right thyroid mass.
POSTOPERATIVE DIAGNOSIS:
Follicular adenoma, right thyroid.
PROCEDURE PERFORMED:
Right thyroid lobectomy
SURGEON:
Charles Richard Frazier, MD
ANESTHESIA:
General.
FINDINGS:
The right thyroid lobe was basically occupied with a 4-5 cm, well
circumscribed, welling encapsulated, slightly inflamed neoplasm
that on fine-needle aspiration had suggested a follicular lesion
with Hurthle cell features. There was no associated adenopathy
in the neck on the right, and there was no evidence of
abnormality of significant abnormality on the left.
SUMMARY:
After induction of adequate general endotracheal anesthesia, the
patient received a vertical intrascapular roll and the neck was
fully extended. The anterior neck and chest were then prepped
and draped in the sterile fashion. A standard collar type
incision was made transversely between the sternocleidomastoid
muscles and carried down sharply through the platysma. Platysmal
flaps were raised superiorly to the level of the cricothyroid
membrane and inferiorly to the sternal notch. The strap muscles
were opened in the midline. The strap muscles were then
carefully dissected off of the right thyroid mass. Carefully the
middle thyroid vein was identified and ligated over 4-0 silk and
then the inferior pole vessels were dealt with in the same way.
It was at this point, with the medial rotation now possible that
the inferior parathyroid on the right was identified and
protected. Carefully the recurrent laryngeal nerve was
identified and during this portion of the dissection the superior
parathyroid was identified and protected. The superior pole
vessels were then divided over 3-0 silk and the gland rotated
medially. Carefully the nodule and the lobe were dissected off
the tracheoesophageal groove protecting the nerve throughout its
course, allowing division of the ligament of Berry, bringing the
lobe and nodule up to the isthmus. The isthmus was then crushed,
clamped and the mass sharply removed. The isthmus was ligated
over running locking 2-0 silk. Immediate pathologic evaluation
suggested a follicular neoplasm, but no evidence of malignant
change was seen and once again, some Hurthle cell features were
noted. Therefore, attention was turned toward closure. In this
regard, the neck was irrigated and hemostasis confirmed with
Avitene. The strap muscles and platysma were closed with
interrupted 3-0 chromic while the skin was closed with running 4-
0 Vicryl in an intracuticular fashion. Steri-Strips and sterile
dressings were applied. Final needle lap sponge and instrument
counts were reported as correct. At extubation the vocal cords
were directly visualized and both were equally mobile. She was
taken to recovery in stable condition.
PREOPERATIVE DIAGNOSIS:
Right thyroid mass.
POSTOPERATIVE DIAGNOSIS:
Follicular adenoma, right thyroid.
PROCEDURE PERFORMED:
Right thyroid lobectomy
SURGEON:
Charles Richard Frazier, MD
ANESTHESIA:
General.
FINDINGS:
The right thyroid lobe was basically occupied with a 4-5 cm, well
circumscribed, welling encapsulated, slightly inflamed neoplasm
that on fine-needle aspiration had suggested a follicular lesion
with Hurthle cell features. There was no associated adenopathy
in the neck on the right, and there was no evidence of
abnormality of significant abnormality on the left.
SUMMARY:
After induction of adequate general endotracheal anesthesia, the
patient received a vertical intrascapular roll and the neck was
fully extended. The anterior neck and chest were then prepped
and draped in the sterile fashion. A standard collar type
incision was made transversely between the sternocleidomastoid
muscles and carried down sharply through the platysma. Platysmal
flaps were raised superiorly to the level of the cricothyroid
membrane and inferiorly to the sternal notch. The strap muscles
were opened in the midline. The strap muscles were then
carefully dissected off of the right thyroid mass. Carefully the
middle thyroid vein was identified and ligated over 4-0 silk and
then the inferior pole vessels were dealt with in the same way.
It was at this point, with the medial rotation now possible that
the inferior parathyroid on the right was identified and
protected. Carefully the recurrent laryngeal nerve was
identified and during this portion of the dissection the superior
parathyroid was identified and protected. The superior pole
vessels were then divided over 3-0 silk and the gland rotated
medially. Carefully the nodule and the lobe were dissected off
the tracheoesophageal groove protecting the nerve throughout its
course, allowing division of the ligament of Berry, bringing the
lobe and nodule up to the isthmus. The isthmus was then crushed,
clamped and the mass sharply removed. The isthmus was ligated
over running locking 2-0 silk. Immediate pathologic evaluation
suggested a follicular neoplasm, but no evidence of malignant
change was seen and once again, some Hurthle cell features were
noted. Therefore, attention was turned toward closure. In this
regard, the neck was irrigated and hemostasis confirmed with
Avitene. The strap muscles and platysma were closed with
interrupted 3-0 chromic while the skin was closed with running 4-
0 Vicryl in an intracuticular fashion. Steri-Strips and sterile
dressings were applied. Final needle lap sponge and instrument
counts were reported as correct. At extubation the vocal cords
were directly visualized and both were equally mobile. She was
taken to recovery in stable condition.