sandy06
Networker
OPERATION PERFORMED:
1. A right video-assisted thoracoscopy.
2. Right thoracotomy.
3. Intrapericardial pneumonectomy.
4. On block resection of the phrenic nerve and pericardium.
5. Mediastinal lymphadenectomy.
6. Bronchial stump reinforcement.
7. Pericardial patch closure of the pericardial defect.
8. Intercostal nerve blocks and placement of On-Q pain management
system.
DESCRIPTION OF PROCEDURE:
The patient was brought to the operating room. The patient had
appropriate monitoring lines placed by Anesthesia. The patient
received preoperative antibiotics. The patient underwent general
endotracheal anesthesia without complication. The patient had an
endobronchial blocker positioned. The position of the block was
verified under fiberoptic bronchoscopy. Thereafter, the patient was
positioned in the right posterolateral thoracotomy position. The
patient was prepped and draped in the usual sterile fashion.
Subsequently, an appropriate surgical time-out was taken. Thereafter,
a 1.5 cm skin incision was made in the ninth intercostal space in the
midaxillary line. Dissection carried down through the subcutaneous
tissue. The right lung was deflated. The pleural space was entered
under direct vision utilizing electrocautery. Thereafter, a 12 mm
trocar port was placed and was hooked to low-flow carbon dioxide
insufflation. Subsequently, a 10 mm x 30 degree Stryker hand-held high-
definition camera was advanced into the pleural space. Upon entering
the pleural space inspection revealed no evidence of any pleural
disease. There was noted to be a large central mass and it appeared to
be free from the mediastinum medially. The decision was made to
proceed with a lateral thoracotomy and a lateral thoracotomy incision
was carried out over the fifth intercostal space. Dissection carried
down through the latissimus dorsi posteriorly. This was raised
anterior and it was identified and it was reflected anteriorly.
Thereafter, two-way freer retractor was used to spread the ribs.
Thereafter, inspection of the mass revealed a very large central mass,
which was adherent into and invading the pericardium and the phrenic
nerve. A decision was made to inspect the central vascular structures
from an intrapericardial approach. The pericardium was then opened.
Inspection revealed that the mass was free of the central structures
amenable to surgical resection. However, the resection would require a
pneumonectomy. Thereafter, attention was turned to the diaphragm, this
was retracted with a downward retraction suture. The inferior
pulmonary ligament was taken up. The pericardium was then tacked open
utilizing pericardial retraction sutures. Thereafter, first the right
superior pulmonary vein, and then subsequently the right inferior
pulmonary vein were divided utilizing a Covidien 45 mm curved tip, tan
load, linear cutting vascular Tri-stapling device. Thereafter, the
main pulmonary artery was controlled with inside the pericardium.
Thereafter, the dissection was carried through the phrenic nerve. The
area of adherent the pericardium was excised on block with the
specimen. The main pulmonary artery was then identified,
extrapericardial, just beneath the superior vena cava and was also
transected utilizing a Covidien 60 mm purple load linear cutting Tri-
stapling device. Thereafter, the mass was resected up to the level of
the bronchus. The main carina was identified and it was elevated up
into the field of vision. A meticulous mediastinal lymphadenectomy was
carried out. All lymph nodes were removed and were sent off to
pathology with appropriate lymph node station labeling. The subcarinal
area was freed of nodal disease. Thereafter, the mainstem bronchus was
transected utilizing a Covidien 60 mm purple load linear cutting Tri-
stapling device. A decision was made to reinforce the bronchial stump
and a pedicle of a of the parietal pleura was just taken above the
reflexion near the esophagus was brought up in a pedicle fashion, 4-0
Prolene sutures were then placed in a simple fashion along the
bronchial stump closure. The pericardium was then fashioned on top of
the stapled end of the bronchus and the Prolene sutures were tied
down. The specimen was removed and was sent off to pathology. Frozen
section analysis revealed the margins to be free of tumor. The chest
was irrigated utilizing warm saline containing antibiotic-containing
solution. Thereafter, a large pericardial patch was brought onto the
field. The pericardial defect was then closed utilizing the
pericardial patch and a 4-0 Prolene running Prolene suture.
Thereafter, intercostal nerve blocks were performed from the third
through the 11th interspace utilizing injectable 0.25% Marcaine. The
patient was given IV Ofirmev. A #32 chest tube was placed through the
camera incision. An On-Q pain management system was brought onto the
field. The On-Q catheters were placed utilizing the percutaneous
delivery system and placed over the neurovascular bundle. Thereafter,
the ribs were reapproximated utilizing #1 Vicryl pericostal sutures.
The muscle and fascia layers were closed utilizing running 0 Vicryl
suture in anatomical layers. The skin was closed utilizing 4-0
Monocryl. Before closing the ninth interspace incision, a red rubber
catheter was placed subcutaneous and muscular layers sutures were
placed. The red rubber catheter was placed under gentle suction and it
was then removed. All the sutures were being tied down. The skin was
closed utilizing 4-0 Monocryl skin closure and reinforced utilizing a
Swiss set. The patient tolerated the procedure well. No complications
were encountered. The specimens removed consisted of the right lung on
block
pericardium and phrenic nerve and all the lymph nodes.
Estimated blood loss was approximately 150 mL.
All instrument counts, lap counts and sponge counts were correct.
The patient was positioned back in the supine position. A portable
chest x-ray was obtained, which revealed the mediastinum to be an
acceptable location. The patient was extubated in the operating room.
The patient was transported to the recovery room in stable, but
critical condition.
Can someone give me some insight on this Opt Report please.
The codes that I have is:
32440
33050
38746
31770
Please let me know if these are correct or if I mist something.
thanks in advance.
1. A right video-assisted thoracoscopy.
2. Right thoracotomy.
3. Intrapericardial pneumonectomy.
4. On block resection of the phrenic nerve and pericardium.
5. Mediastinal lymphadenectomy.
6. Bronchial stump reinforcement.
7. Pericardial patch closure of the pericardial defect.
8. Intercostal nerve blocks and placement of On-Q pain management
system.
DESCRIPTION OF PROCEDURE:
The patient was brought to the operating room. The patient had
appropriate monitoring lines placed by Anesthesia. The patient
received preoperative antibiotics. The patient underwent general
endotracheal anesthesia without complication. The patient had an
endobronchial blocker positioned. The position of the block was
verified under fiberoptic bronchoscopy. Thereafter, the patient was
positioned in the right posterolateral thoracotomy position. The
patient was prepped and draped in the usual sterile fashion.
Subsequently, an appropriate surgical time-out was taken. Thereafter,
a 1.5 cm skin incision was made in the ninth intercostal space in the
midaxillary line. Dissection carried down through the subcutaneous
tissue. The right lung was deflated. The pleural space was entered
under direct vision utilizing electrocautery. Thereafter, a 12 mm
trocar port was placed and was hooked to low-flow carbon dioxide
insufflation. Subsequently, a 10 mm x 30 degree Stryker hand-held high-
definition camera was advanced into the pleural space. Upon entering
the pleural space inspection revealed no evidence of any pleural
disease. There was noted to be a large central mass and it appeared to
be free from the mediastinum medially. The decision was made to
proceed with a lateral thoracotomy and a lateral thoracotomy incision
was carried out over the fifth intercostal space. Dissection carried
down through the latissimus dorsi posteriorly. This was raised
anterior and it was identified and it was reflected anteriorly.
Thereafter, two-way freer retractor was used to spread the ribs.
Thereafter, inspection of the mass revealed a very large central mass,
which was adherent into and invading the pericardium and the phrenic
nerve. A decision was made to inspect the central vascular structures
from an intrapericardial approach. The pericardium was then opened.
Inspection revealed that the mass was free of the central structures
amenable to surgical resection. However, the resection would require a
pneumonectomy. Thereafter, attention was turned to the diaphragm, this
was retracted with a downward retraction suture. The inferior
pulmonary ligament was taken up. The pericardium was then tacked open
utilizing pericardial retraction sutures. Thereafter, first the right
superior pulmonary vein, and then subsequently the right inferior
pulmonary vein were divided utilizing a Covidien 45 mm curved tip, tan
load, linear cutting vascular Tri-stapling device. Thereafter, the
main pulmonary artery was controlled with inside the pericardium.
Thereafter, the dissection was carried through the phrenic nerve. The
area of adherent the pericardium was excised on block with the
specimen. The main pulmonary artery was then identified,
extrapericardial, just beneath the superior vena cava and was also
transected utilizing a Covidien 60 mm purple load linear cutting Tri-
stapling device. Thereafter, the mass was resected up to the level of
the bronchus. The main carina was identified and it was elevated up
into the field of vision. A meticulous mediastinal lymphadenectomy was
carried out. All lymph nodes were removed and were sent off to
pathology with appropriate lymph node station labeling. The subcarinal
area was freed of nodal disease. Thereafter, the mainstem bronchus was
transected utilizing a Covidien 60 mm purple load linear cutting Tri-
stapling device. A decision was made to reinforce the bronchial stump
and a pedicle of a of the parietal pleura was just taken above the
reflexion near the esophagus was brought up in a pedicle fashion, 4-0
Prolene sutures were then placed in a simple fashion along the
bronchial stump closure. The pericardium was then fashioned on top of
the stapled end of the bronchus and the Prolene sutures were tied
down. The specimen was removed and was sent off to pathology. Frozen
section analysis revealed the margins to be free of tumor. The chest
was irrigated utilizing warm saline containing antibiotic-containing
solution. Thereafter, a large pericardial patch was brought onto the
field. The pericardial defect was then closed utilizing the
pericardial patch and a 4-0 Prolene running Prolene suture.
Thereafter, intercostal nerve blocks were performed from the third
through the 11th interspace utilizing injectable 0.25% Marcaine. The
patient was given IV Ofirmev. A #32 chest tube was placed through the
camera incision. An On-Q pain management system was brought onto the
field. The On-Q catheters were placed utilizing the percutaneous
delivery system and placed over the neurovascular bundle. Thereafter,
the ribs were reapproximated utilizing #1 Vicryl pericostal sutures.
The muscle and fascia layers were closed utilizing running 0 Vicryl
suture in anatomical layers. The skin was closed utilizing 4-0
Monocryl. Before closing the ninth interspace incision, a red rubber
catheter was placed subcutaneous and muscular layers sutures were
placed. The red rubber catheter was placed under gentle suction and it
was then removed. All the sutures were being tied down. The skin was
closed utilizing 4-0 Monocryl skin closure and reinforced utilizing a
Swiss set. The patient tolerated the procedure well. No complications
were encountered. The specimens removed consisted of the right lung on
block
pericardium and phrenic nerve and all the lymph nodes.
Estimated blood loss was approximately 150 mL.
All instrument counts, lap counts and sponge counts were correct.
The patient was positioned back in the supine position. A portable
chest x-ray was obtained, which revealed the mediastinum to be an
acceptable location. The patient was extubated in the operating room.
The patient was transported to the recovery room in stable, but
critical condition.
Can someone give me some insight on this Opt Report please.
The codes that I have is:
32440
33050
38746
31770
Please let me know if these are correct or if I mist something.
thanks in advance.