DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS:
Left upper lobe mass.
POSTOPERATIVE DIAGNOSIS:
Left upper lobe mass.
PROCEDURES PERFORMED:
1. Bronchoscopy.
2. Left thoracotomy with left upper lobe mass wedge excision.
3. Placement of On-Q pain pump.
SURGEON: John Doe, MD
ANESTHESIA: General.
OPERATIVE FINDING: The left upper lobe mass was clearly palpable in a portion of the upper lobe. It was wedged out and frozen section analysis revealed adenocarcinoma with clear margins. There were no other palpable nodules. There was no evidence of any effusion or any overt lymphadenopathy or parietal pleural involvement.
DESCRIPTION OF PROCEDURE: The patient was brought to the operating room and placed supine on the operating table. General anesthesia was induced. There was some difficulty placing the double lumen endotracheal tube, so we performed bronchoscopy, which was then used to guide the tube into correct position. At the time of bronchoscopy, it was noted that the right mainstem bronchus appeared normal, as did the takeoff of the right upper lobe bronchus. The bronchus intermedius was clearly visualized, and the right lower lobe bronchus staple line was then checked. The left mainstem bronchus appeared normal as did the lobar and segmental bronchi on the left. The patient was then positioned in the right lateral decubitus position. The left chest was prepped and draped in the usual sterile fashion. A left lateral muscle-sparing thoracotomy was made in the fourth intercostal space. The nodule was palpated, and it was wedged out using multiple reloads of a thick tissue EZ45 stapler. The specimen was sent to pathology, which confirmed clean margins and showed the mass to be consistent with adenocarcinoma. After assuring adequate hemostasis, a left 32-French pleural chest tube was placed and secured with 0 Vicryl suture. The ribs were then approximated with #2 pericostal stitches and then an On-Q pain catheter was placed. A dual layer muscular closure was performed with 0 Vicryl suture and then an additional On-Q pain catheter was placed in the subcutaneous tissues, which were closed with 2-0 Vicryl suture. The skin was approximated with 4-0 Monocryl in a running subcuticular fashion. Steri-Strips and sterile dressing were applied. The patient tolerated the procedure well without any complications. Estimated blood loss was 50 mL. The patient was extubated and transferred to the recovery room in stable condition. Sponge and needle count was correct at the end of the case.
DATE OF PROCEDURE: MM/DD/YYYY
PROCEDURE PERFORMED: Bronchoscopy.
INDICATION FOR PROCEDURE: Chronic congestion with inability to expectorate secretions.
PREOPERATIVE DIAGNOSIS: Mucus plugging.
POSTOPERATIVE DIAGNOSIS: Mucus plugging.
The patient understood the risk of bleeding, infection, pneumothorax, and death and wished to proceed.
DESCRIPTION OF PROCEDURE: The patient was brought to the endoscopy suite. She received a total of 100 mcg of fentanyl and 3 mg of Versed. Once adequate sedation was achieved, liquid followed by viscous lidocaine was instilled into the nares bilaterally. Flexible fiberoptic bronchoscope was entered into the right naris. Posterior pharynx and vocal cords were abnormal. There was a nodularity to the vocal cords, the arytenoid area. Distally, the trachea was normal, except copious amounts of thick brown secretions were seen bilaterally. These were extremely tenacious. Multiple 10 mL saline lavages were needed to clean out the trachea. Distally, the right mainstem, right upper lobe, right middle lobe, and right lower bronchi were seen. Again, copious amounts of thick brown secretions without lesions. The mucosa was extremely erythematous and edematous. Multiple 10 mL saline lavages were used to clean out the base of the segments. Left mainstem, left upper lobe, and left lower bronchi were seen. Moderate to significant amount of purulent secretions were noted. Multiple 10 mL saline lavages were needed to clean that out. Significant secretions were aspirated. The patient tolerated the procedure well. The patient did have some transient hypoxemia that responded to increased FiO2.
IMPRESSION:
1. Significant mucus plugging. No lesions.
2. Chronic bronchitic changes.
