TWilliam2019
Guru
postoperative diagnosis:
#1 anterior pericardial cyst
#2 atypical chest discomfort
*
procedure:
#1 right robotic-assisted thoracoscopic resection of anterior pericardial cyst 39200 modifier 22 bc of robotic would this be correct?
*
Intraoperative findings:
Large pericardial cyst herniating laterally into the right pleural space. Origin of the cyst was along the distal greater curvature of the aorta. No inflammatory findings identified. Pericardial fluid was serous in nature. Full resection was performed with a 1 x 1.5 cm defect left in the pericardial sac near the distal greater curvature of the aorta.
*
Procedure in detail:
The patient had her history and physical updated prior to the procedure. She was transferred to the operating suite and placed on the operating table where she underwent general anesthesia with endotracheal intubation. Monitoring lines were placed by anesthesia. The patient was wrapped and draped in usual sterile fashion using ChloraPrep solution. Timeout was used confirm patient identity as well as the surgery to be performed. Antibiotics given prior the incision.
*
Small 8 mm incision was made at roughly the fifth intercostal space, mid axillary line on the right. Soft tissues were divided with cautery. The introducer needle was then inserted into the right pleural space and the right pleural space was insufflated with CO2 to a pressure of 4 mmHg. The camera port was then placed. Once this was completed, an 8 mm port was placed inferiorly at approximately the eighth intercostal space, anterior axillary line. A superior port was placed near the right axilla. This was all performed under direct visualization.
*
The da Vinci SI system was then docked in the usual fashion. Once this was completed, caudier graspers were inserted. Gross inspection of the pericardial cyst was performed. Using bipolar as well as monopolar dissection, the pericardial fat and thymic tissue were released from the pericardial cyst and the neck was identified at the along the greater curvature of the aorta. The pericardial cyst was then opened with monopolar cautery. Serous fluid was drained which allowed for excellent visualization of the neck and the cyst. The cyst was then completely removed and submitted for permanent specimen. A 1 x 1.5 cm defect was left in the pericardium at the most distal aspect of the ascending aorta.
*
A 24 French Silastic chest tube was then placed anteriorly and positioned near the working site. Ports were removed under direct visualization and found to hemostatic. Camera was removed and all incision sites were closed in layers, with 2-0 Vicryl being used to close the soft tissues. Skin was closed with 4 Monocryl running subcuticular manner. The soft tissues had been injected with half percent Marcaine for local anesthesia. The patient tolerated the procedure well, was extubated, then transferred recovery.
*
Specimens: Pericardial cyst
estimated blood loss: Less than 5 mL's
blood replaced: None
drains: 24 French Silastic chest tube
implants: None
condition at completion of procedure: Stable
#1 anterior pericardial cyst
#2 atypical chest discomfort
*
procedure:
#1 right robotic-assisted thoracoscopic resection of anterior pericardial cyst 39200 modifier 22 bc of robotic would this be correct?
*
Intraoperative findings:
Large pericardial cyst herniating laterally into the right pleural space. Origin of the cyst was along the distal greater curvature of the aorta. No inflammatory findings identified. Pericardial fluid was serous in nature. Full resection was performed with a 1 x 1.5 cm defect left in the pericardial sac near the distal greater curvature of the aorta.
*
Procedure in detail:
The patient had her history and physical updated prior to the procedure. She was transferred to the operating suite and placed on the operating table where she underwent general anesthesia with endotracheal intubation. Monitoring lines were placed by anesthesia. The patient was wrapped and draped in usual sterile fashion using ChloraPrep solution. Timeout was used confirm patient identity as well as the surgery to be performed. Antibiotics given prior the incision.
*
Small 8 mm incision was made at roughly the fifth intercostal space, mid axillary line on the right. Soft tissues were divided with cautery. The introducer needle was then inserted into the right pleural space and the right pleural space was insufflated with CO2 to a pressure of 4 mmHg. The camera port was then placed. Once this was completed, an 8 mm port was placed inferiorly at approximately the eighth intercostal space, anterior axillary line. A superior port was placed near the right axilla. This was all performed under direct visualization.
*
The da Vinci SI system was then docked in the usual fashion. Once this was completed, caudier graspers were inserted. Gross inspection of the pericardial cyst was performed. Using bipolar as well as monopolar dissection, the pericardial fat and thymic tissue were released from the pericardial cyst and the neck was identified at the along the greater curvature of the aorta. The pericardial cyst was then opened with monopolar cautery. Serous fluid was drained which allowed for excellent visualization of the neck and the cyst. The cyst was then completely removed and submitted for permanent specimen. A 1 x 1.5 cm defect was left in the pericardium at the most distal aspect of the ascending aorta.
*
A 24 French Silastic chest tube was then placed anteriorly and positioned near the working site. Ports were removed under direct visualization and found to hemostatic. Camera was removed and all incision sites were closed in layers, with 2-0 Vicryl being used to close the soft tissues. Skin was closed with 4 Monocryl running subcuticular manner. The soft tissues had been injected with half percent Marcaine for local anesthesia. The patient tolerated the procedure well, was extubated, then transferred recovery.
*
Specimens: Pericardial cyst
estimated blood loss: Less than 5 mL's
blood replaced: None
drains: 24 French Silastic chest tube
implants: None
condition at completion of procedure: Stable