DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Right upper lobe lung mass.
2. Right hilar adenopathy.
3. History of colon cancer.
POSTOPERATIVE DIAGNOSES:
1. Right upper lobe lung mass.
2. Right hilar adenopathy.
3. History of colon cancer.
PROCEDURES PERFORMED:
1. Flexible bronchoscopy with right upper lobe lavage, brushing, and transbronchial biopsy.
2. Cervical mediastinoscopy with biopsy.
SURGEON: John Doe, MD
ANESTHESIA: General endotracheal.
ESTIMATED BLOOD LOSS: 20 mL.
COMPLICATIONS: None apparent.
FINDINGS: Friable mass in the anterior segment of the right upper lobe of the lung. Negative mediastinal lymph nodes on frozen section.
DESCRIPTION OF OPERATION: The patient was brought to the operating room and placed in the supine position. Following smooth induction of general endotracheal anesthesia, an 8.0 endotracheal tube was placed and position was confirmed. Flexible bronchoscopy was performed. The trachea, right and left mainstem bronchi, left upper lobe, left lower lobe, right middle lobe, and right lower lobe bronchi were all normal. There appeared to be some distortion of the posterior segmental bronchus. Lavage, brushings, and biopsies were performed with transbronchial biopsy of this site and sent to pathology. Neck was then extended in the midline. The anterior neck, chest, and shoulders were prepared in the sterile fashion. A time-out was taken to confirm correct patient, correct side, and correct procedure. Preoperative antibiotics had been administered. Subcutaneous heparin had been administered. Compression boots were on the lower extremities.
A 3 cm transverse low collar incision was performed after infiltration with Marcaine 0.25% with epinephrine. Sharp dissection was carried down to the strap muscles. The strap muscles were separated in the midline. The pretracheal fascia was identified and incised. The mediastinum was explored. There were soft anthracotic lymph nodes in the subcarinal, right tracheobronchial angle, and right paratracheal region. Biopsies were taken from level 7, level 10R, and level 2R, and sent to pathology. Frozen sections at level 7, 10, and 4 were all negative for malignancy. Final pathology is pending. The mediastinum was packed with a gauze sponge. Five minutes was allowed for tamponade. The mediastinum was explored. There was good hemostasis. Gauze packing had been removed. The mediastinum was explored. There was good hemostasis. Additional Marcaine 0.25% with epinephrine was used for local block. A total of 15 mL was administered. The strap muscles were reapproximated with 2-0 Vicryl sutures. The subcutaneous layer was closed with interrupted 2-0 Vicryl sutures. The skin was approximated with a 4-0 Monocryl subcuticular skin stitch. The incision was sealed with Dermabond.
The initial transbronchial biopsies showed no evidence of malignancy. Mediastinal lymph nodes were negative on frozen section. Sponge and needle counts were correct. Repeat flexible bronchoscopy was performed. Through the anterior segmental bronchus out beyond in the subsegmental bronchi, we could just make out what appeared to be whitish tissue in a segmental bronchus. Transbronchial biopsies were taken of this tissue. There was some mild amount of bleeding with biopsy, which was controlled with dilute 1:100,000 epinephrine saline solution. Four separate biopsies were taken, placed in a specimen bag, and sent to pathology for routine pathologic evaluation. The airways were aspirated clear. There was good hemostasis. The bronchoscope was removed. The patient awoke from general anesthesia without difficulty. The patient was extubated and transported to the postanesthesia care unit in satisfactory condition.
