mhanson1
Networker
I just wanted to run this by the board for verification.
Operation:
Left thoracotomy with stapling blebs and mechanical and chemical pleurodesis with talc.
Procedure:
With the patient in the supine position on the operating table following induction of general anesthesia, the patient was positioned in the right lateral decubitus position with the left side up. The left chest was prepped and draped. A left posterolateral thoractomy skin incision was made. The chest was entered through the fifth intercostal space. Upon entering the chest, there were multiple adhesions from the lung to the lateral chest wall. These were carfully divided and lung was gradually mobilized. There was fairly extensive scarring and initially the upper portion of the lung was mobilized. Finally, the apex was able to be freed. Identified a bleb that was leaking right at the apex. This was stapled using an EndoGIA with a 45 load. We fired multiple times. When that was done, the remainder of the upper portion of the lung was mobilized so the the entire left upper lobe was free. Next, the left lower portion of the lung was gradually mobilized. The lung was hyperinflated so it was difficult to entirely free the lung because of difficulty visualizing the lower portion and the density of the adhesions. I mobilized as much as possible, then went ahead and did a mechanical pleurodesis using a Bovie scratch pad. After the pleura was roughened throughout, we obtained talc and emptied the entire talc bottle into the pleural space and tried to move it around as much as possible so that it was spread evenly along the lung surface and the pleural surface. Next two 36 argyle chest tubes were brought through stab wounds and placed in the pleural space. A right angle tube was placed posteriorly and anterior. A straight tube was placed to the apex. These were sutured to the skin. Then eight #1 Vicryl pericostal sutures were placed around the ribs and the ribs reapproximated. The muscles were closed using running - Victryl sutrue. The subcutaneous was closed with 3-0 Vicryl and the skin was closed with staples. The incision was dressed and the patient was taken back to the intensive care unit intubated.
I am looking at 32141 for the stapling of the bleb. Do you see anything I may have missed? Thanks in advance!
Michelle
Operation:
Left thoracotomy with stapling blebs and mechanical and chemical pleurodesis with talc.
Procedure:
With the patient in the supine position on the operating table following induction of general anesthesia, the patient was positioned in the right lateral decubitus position with the left side up. The left chest was prepped and draped. A left posterolateral thoractomy skin incision was made. The chest was entered through the fifth intercostal space. Upon entering the chest, there were multiple adhesions from the lung to the lateral chest wall. These were carfully divided and lung was gradually mobilized. There was fairly extensive scarring and initially the upper portion of the lung was mobilized. Finally, the apex was able to be freed. Identified a bleb that was leaking right at the apex. This was stapled using an EndoGIA with a 45 load. We fired multiple times. When that was done, the remainder of the upper portion of the lung was mobilized so the the entire left upper lobe was free. Next, the left lower portion of the lung was gradually mobilized. The lung was hyperinflated so it was difficult to entirely free the lung because of difficulty visualizing the lower portion and the density of the adhesions. I mobilized as much as possible, then went ahead and did a mechanical pleurodesis using a Bovie scratch pad. After the pleura was roughened throughout, we obtained talc and emptied the entire talc bottle into the pleural space and tried to move it around as much as possible so that it was spread evenly along the lung surface and the pleural surface. Next two 36 argyle chest tubes were brought through stab wounds and placed in the pleural space. A right angle tube was placed posteriorly and anterior. A straight tube was placed to the apex. These were sutured to the skin. Then eight #1 Vicryl pericostal sutures were placed around the ribs and the ribs reapproximated. The muscles were closed using running - Victryl sutrue. The subcutaneous was closed with 3-0 Vicryl and the skin was closed with staples. The incision was dressed and the patient was taken back to the intensive care unit intubated.
I am looking at 32141 for the stapling of the bleb. Do you see anything I may have missed? Thanks in advance!
Michelle