DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Spontaneous left pneumothorax
2. Status post insertion of left chest tube with persistent pneumothorax.
3. Chronic obstructive pulmonary disease/severe emphysema.
4. Remote tobacco use.
5. Coronary artery disease.
POSTOPERATIVE DIAGNOSES:
1. Spontaneous left pneumothorax
2. Status post insertion of left chest tube with persistent pneumothorax.
3. Chronic obstructive pulmonary disease/severe emphysema.
4. Remote tobacco use.
5. Coronary artery disease.
OPERATION PERFORMED:
1. Exploratory left thoracotomy.
2. Segmental resection of left upper lobe with resection of multiple bullae.
3. Mechanical pleurodesis.
4. Intercostal nerve block using Marcaine from intercostal space third to eighth.
5. Insertion of an On-Q pump.
SURGEON: John Doe, MD
ANESTHESIA: General.
ESTIMATED BLOOD LOSS: 50 mL.
DRAINS: Two chest tubes.
FINDINGS: The patient had large left pneumothorax with multiple adhesions from left upper lobe to the chest wall as well as multiple adhesions from the left lower lobe to the chest wall. The patient had severe emphysematous changes, especially in the left upper lobe with multiple bullae, especially in the left upper lobe. One of those bullae had ruptured with active air leak.
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 using the double lumen endotracheal tube.
After this was performed, the patient was placed in the right decubitus lateral position, and the left chest was prepped and draped in the usual sterile fashion. A posterolateral left thoracotomy was performed using the muscle-sparing technique. After this was performed, the chest cavity was identified at the fifth intercostal space. Rib protectors were placed. Lysis of adhesions between the left upper lobe and chest wall as well as left lobe adhesions between the left lower lobe and chest wall were performed.
After the left upper lobe and left lower lobe were completely mobilized, the lung was examined carefully. Multiple bullae were found at the apex of the left upper lobe. One of those was ruptured with active air leak. Segmental resection of all the bullae and emphysematous left upper lobe was removed. This was performed with a GIA stapler protected with pericardial patches.
After this was performed, the rest of the lung was examined. The lung was inflated and checked for air leaks. Small areas of air leak were then treated with Tisseel. While this was performed, mechanical pleurodesis was performed. Following this, intercostal nerve block was performed using 0.25% Marcaine. This was done from intercostal nerves three to eight.
After this was performed, two chest tubes were placed in the left chest cavity and secured with itself. Following this, the chest wall was closed in layers. Previous to this, two small On-Q pump catheters were placed below and above the muscle layers and connected to a pain management pump device. Following this, the wound was closed in layers. The patient tolerated the procedure and was transferred to the cardiovascular recovery unit in stable condition.
