CRC CPC
Guru
I am thinking 32100 Any Ideas?
A thoracotomy was performed in standard fashion. Approximately four
inches were then utilized to make a very small incision. Dissection
was taken down to the fascia and through the muscle. The ribs were
spread without any rib breakage. The AP window nodes were then
evaluated and several nodes were sent, all showing just anthracotic
nodes. The pulmonary artery was clearly dissected free. The bronchus
was dissected anteriorly. The aorta itself was cleaned appropriately
all the way down to the take off of the left subclavian and carotid.
We spent approximately five and half hours searching for the
parathyroid adenoma with 11 total specimens sent, all negative for
parathyroid adenoma. At this point in time we confirmed our
location. We felt that we were in the correct place. It was supposed
to be just anterior and lateral to the bronchus and just inferior
and posterior to the major aorta as it approaches the arch.
Confirmation was also obtained with full visualization of all major
structures of the pulmonary arteries, the aorta, and the bronchus.
Discussion was undertaken with Dr. zz the radiologist at Compass
Imaging and again we felt very comfortable we were in the right
place, we simply just could not find the parathyroid adenoma. All
specimens obtained which were just nodes. The phrenic nerve was
clearly visualized and kept out of harm's way. The vagus nerve and
what appeared to be recurrent was clearly visualized and kept out of
harm's way as well. One chest tube was placed, a RibLoc and standard
closure. Dr.x will dictate a separate operative note for the
surgical exploration and I am dictating the operative note for the
thoracotomy and assisting the parathyroid adenoma exploration.
A thoracotomy was performed in standard fashion. Approximately four
inches were then utilized to make a very small incision. Dissection
was taken down to the fascia and through the muscle. The ribs were
spread without any rib breakage. The AP window nodes were then
evaluated and several nodes were sent, all showing just anthracotic
nodes. The pulmonary artery was clearly dissected free. The bronchus
was dissected anteriorly. The aorta itself was cleaned appropriately
all the way down to the take off of the left subclavian and carotid.
We spent approximately five and half hours searching for the
parathyroid adenoma with 11 total specimens sent, all negative for
parathyroid adenoma. At this point in time we confirmed our
location. We felt that we were in the correct place. It was supposed
to be just anterior and lateral to the bronchus and just inferior
and posterior to the major aorta as it approaches the arch.
Confirmation was also obtained with full visualization of all major
structures of the pulmonary arteries, the aorta, and the bronchus.
Discussion was undertaken with Dr. zz the radiologist at Compass
Imaging and again we felt very comfortable we were in the right
place, we simply just could not find the parathyroid adenoma. All
specimens obtained which were just nodes. The phrenic nerve was
clearly visualized and kept out of harm's way. The vagus nerve and
what appeared to be recurrent was clearly visualized and kept out of
harm's way as well. One chest tube was placed, a RibLoc and standard
closure. Dr.x will dictate a separate operative note for the
surgical exploration and I am dictating the operative note for the
thoracotomy and assisting the parathyroid adenoma exploration.