DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS:
Anterior mediastinal mass.
POSTOPERATIVE DIAGNOSIS:
Thymic hypoplasia.
PROCEDURE PERFORMED:
Computer-assisted telemanipulation surgery for resection of anterior mediastinal mass.
SURGEON: John Doe, MD
ANESTHESIA: General.
INDICATIONS FOR PROCEDURE: The patient is a (XX)-year-old female who was undergoing workup for some musculoskeletal chest wall pain. This included CT scan of the chest, which demonstrated an anterior medistinal mass. This was shown to be PET scan positive, and the patient presents today for definitive resection for diagnosis. The patient understands the risks and possible complications of the procedures and wishes to proceed.
OPERATIVE FINDINGS: The multilobulated mass was located in the fatty tissue between the pericardium and the sternum. It was quite soft and friable. The frozen section revealed it to be a benign process, most likely in keeping with thymic hyperplasia.
DESCRIPTION OF PROCEDURE: The patient was brought to the operating room and placed supine on the operating table. General anesthesia was induced without complication. The patient was positioned with a roll underneath the right side. A 10 mm port was placed in the fourth intercostal space in the mid axillary line. Two additional 8 mm ports were placed in the second and sixth intercostal spaces in the anterior axillary line. The robot was then docked. The instruments were placed.
Using cautery as well as grasping device, the fat pad was opened just anterior to the phrenic nerve on the right. This plane was followed at the level of the pericardium, extending towards the midline and then over towards the left side. Some of the small veins in the fat pad, that were tributaries of the innominate vein, were clipped and then divided. The mass itself was separated form the pericardium. As it had been broken to pieces, several pieces were sent for frozen section with findings as noted above. The remainder, including the associated fat over to the left side, was all removed en bloc in an endobag. The surgical site was irrigated and Tisseel applied with good results.
The robot was then undocked, and the ports were all removed. A 28-French chest tube was left through the port in the sixth intercostal space, and this was secured with 0 Vicryl suture. The remaining two port sites were closed with 0 Vicryl and 3-0 Vicryl suture and 4-0 Monocryl running subcuticular closure. Steri-Strips and sterile dressings were applied. The patient tolerated the procedure well without any complications. Estimated blood loss was 100 mL. The patient was transferred extubated and in stable condition to the recovery room. Sponge and needle counts were correct at the end of the case.
