ShandaAndrews10
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CPT CODE FOR PYELOPLASTY THROUGH DORSAL LUMBOTOMY ---PRONE!!!!
Operative Note ---
He was placed in prone position. All pressure areas were well padded. A 2.5 cm incision was made on the left side and deepened through skin and subcutaneous tissue. Scarpa fascia was opened. Dorsolumbar fascia was visualized. With blunt and sharp dissection, it was dissected away from the fat. Planes were created more superiorly and Inferiorly. A vertical incision was marked around the paraspinal region. The fascia was opened. The retroperitoneum was entered. Pelvis was visualized. It was then drawn into the incision. Stay suture was placed with 4-0 chromic. The UPJ was dissected. Stay sutures were placed at the inferior aspect of the pelvis as well as on the ureter. The pyelostomy in the UPJ was then disconnected and spatulated on the posterolateral aspect. Anastomosis was performed with 7-0 Vicryl with 3 anchoring sutures at 5, 6 and 7 o'clock positions and running anastomosis with 7-0 Vicryl was performed on the anterior layer and then the posterior layer. Antegrade stent insertion was placed with 4.7 x 12 cm over 0.025 Glidewire. Retrograde efflux of the methylene blue confirmed the position of the distal coil into the bladder. Proximal end was placed into the pelvis. Renal pelvis was irrigated of any clots. The rest of the anastomosis was completed which was watertight, dependent and wide. Hemostasis was confirmed. Gerota fascia was closed with 5-0 chromic. Lumbodorsal fascia was closed with 3-0 Vicryl. Scarpa's was approximated with 3-0 Vicryl, subcutaneous with 4-0 Vicryl, and skin with 5-0 Monocryl in subcuticular fashion.
Thank you!!
Operative Note ---
He was placed in prone position. All pressure areas were well padded. A 2.5 cm incision was made on the left side and deepened through skin and subcutaneous tissue. Scarpa fascia was opened. Dorsolumbar fascia was visualized. With blunt and sharp dissection, it was dissected away from the fat. Planes were created more superiorly and Inferiorly. A vertical incision was marked around the paraspinal region. The fascia was opened. The retroperitoneum was entered. Pelvis was visualized. It was then drawn into the incision. Stay suture was placed with 4-0 chromic. The UPJ was dissected. Stay sutures were placed at the inferior aspect of the pelvis as well as on the ureter. The pyelostomy in the UPJ was then disconnected and spatulated on the posterolateral aspect. Anastomosis was performed with 7-0 Vicryl with 3 anchoring sutures at 5, 6 and 7 o'clock positions and running anastomosis with 7-0 Vicryl was performed on the anterior layer and then the posterior layer. Antegrade stent insertion was placed with 4.7 x 12 cm over 0.025 Glidewire. Retrograde efflux of the methylene blue confirmed the position of the distal coil into the bladder. Proximal end was placed into the pelvis. Renal pelvis was irrigated of any clots. The rest of the anastomosis was completed which was watertight, dependent and wide. Hemostasis was confirmed. Gerota fascia was closed with 5-0 chromic. Lumbodorsal fascia was closed with 3-0 Vicryl. Scarpa's was approximated with 3-0 Vicryl, subcutaneous with 4-0 Vicryl, and skin with 5-0 Monocryl in subcuticular fashion.
Thank you!!