Wiki R VATS vs Thoracotomy


Pataskala, OH
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...I performed a right thracoscopy through three 1.5 cm incisions. We idenitified the pulmonary nodule in the right upper lobe and resected this using multiple firings of a GIA stapler. We sent this to pathology for frozen section and it came back consisent with non-small cell lung cancer. At this point, we enlarged one of our incisions, and performed a right muscle-sparing thracotomy continuing to use a video assistance. At this point, we identified the vessels and we took the arterial and venous branches using multiple firings of a vascular stapler. We then completed the fissure and resected the bronchus using a TA yellow stapler after inflating the lower and middle lobes to ensure that we did not constrict the airway. We resected this sharply and sent the completion lobectomy to pathology for diagnosis and they informed us that our margin was clear of tumor. We then reinforced the bronchus using pledgeted Prolene sutures. We took down the inferior pulmomary ligament and we collected lymph nodes from levels 8,9, and 7. We did not identify any lymph nodes at level 2 or 4. We also sent hilar lymph nodes. We tested the bronchus and the staple line under saline and we did not see evidence of a leak. We placed straight and right angle chest tubes. We mobilized the intercostal nerve so we did not catch it with our closure stitches and we placed and on Q-pump posterior to the surgical field outside of the ribs. We closed the incision in a standard fashion. Bronchoscopy was clear of endobronchial lesions. The patient tolerated the procedure well......

I'm thinking 32666,32668, 32663, 32674 but then he used the term "thoracotomy" but still using the the video assistance.... I may need to rethink this. When I asked the physician about the enlargement of one of the incisions, he stated that he made the incision approximately 1 and a half inches larger which is much smaller than a "normal" thoracotomy incision.

Any thoughts or comments would appreciated!!