DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Fever of unknown origin.
2. Large mediastinal and hilar adenopathy.
3. Elevated liver function tests.
4. Anemia.
POSTOPERATIVE DIAGNOSES:
1. Fever of unknown origin.
2. Large mediastinal and hilar adenopathy.
3. Elevated liver function tests.
4. Anemia.
5. Rule out lymphoma.
OPERATION PERFORMED:
1. Mediastinoscopy.
2. Mediastinal lymph node biopsy with frozen section.
3. Insertion of left subclavian MediPort device under fluoroscopy.
SURGEON: John Doe, MD
ANESTHESIA: General.
ANESTHESIOLOGIST: Jane Doe, MD
ESTIMATED BLOOD LOSS: Minimal.
SPECIMENS: Multiple lymph nodes.
OPERATIVE FINDINGS: The patient had enlarged multiple, soft upper pretracheal and lower paratracheal lymph nodes. Pathology report showed abnormal lymph nodes suggestive of lymphoma.
DESCRIPTION OF OPERATION: The patient was taken to the operating room and placed on the operating table in the supine position and support lines were placed. General anesthesia was given via endotracheal intubation. The neck and anterior chest were prepped and draped in the usual sterile fashion. A transverse incision was performed approximately 3 cm above the sternal notch. This incision was taken down through skin and subcutaneous tissue and platysma. Hemostasis was achieved using Bovie cautery. The anterior cervical fascia was then opened at the midline, and using blunt and sharp dissection, the anterior aspect of the trachea was dissected free from its surrounding tissues. After this was performed, a mediastinoscope was placed and mediastinoscopy was performed.
After adequate mediastinoscopy was performed, multiple lymph node biopsies were taken from upper pretracheal and lower paratracheal lymph nodes. Frozen section showed abnormal lymph nodes and this was suggestive of lymphoma. In view of this, hemostasis was achieved. No other biopsies were taken. After adequate hemostasis was obtained, the mediastinoscope was removed.
Following this, the wound was closed in layers. In view of the report of a possible lymphoma and that the patient would need chemotherapy, a MediPort was placed. Using an 18 gauge needle, access to the left subclavian vein was gained. After this was performed, a guidewire was advanced through the needle towards the right atrium under fluoroscopic guidance. Once in the atrium, the 18 gauge needle was removed.
Next, two incisions were performed, a small one at the insertion site of the guidewire and a larger one approximately 3 cm below it. The second incision was taken down through skin and subcutaneous tissue down to the pectoralis major fascia. Using blunt and sharp dissection, a subcutaneous pocket was then created. After this was performed, a subcutaneous tunnel was created between the two incisions and a central line catheter was placed in the previously created subcutaneous tunnel. After this was performed, and using the Seldinger technique, the central line catheter was advanced towards the superior vena cava/right atrium under fluoroscopic guidance. Once in this position, the introducer was removed and the proximal aspect of the catheter was connected to a MediPort device. This MediPort device was then placed in the previously created subcutaneous pocket.
The wound was irrigated with antibiotic solution. Hemostasis was obtained. After this was performed, we checked again the position of the MediPort device and the central line catheter and they were in good position. Next, the wound was closed in layers. The patient tolerated the procedure well and was transferred to the cardiovascular recovery unit in stable condition.
