DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Right lower lobe lung nodule.
2. History of metastatic uterine sarcoma to the lung.
POSTOPERATIVE DIAGNOSES:
1. Right lower lobe lung nodule.
2. History of metastatic uterine sarcoma to the lung.
3. Metastatic sarcoma, right lower lobe of the lung.
PROCEDURE PERFORMED: Right fifth, sixth, seventh, and eighth intercostal space intercostal blocks with Marcaine 0.25% with epinephrine.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, PA
ANESTHESIA: General endotracheal.
ESTIMATED BLOOD LOSS: 20 mL.
COMPLICATIONS: None apparent.
INDICATIONS FOR PROCEDURE: The patient is an (XX)-year-old woman with a history of metastatic uterine sarcoma to the left lung. Surveillance CT scan of the chest showed a new noncalcified right lower lobe lung nodule consistent with metastatic sarcoma. The patient was counseled on the risks, benefits, and alternatives to a right thoracoscopy with wedge resection, excisional biopsy. Informed consent was obtained.
DESCRIPTION OF PROCEDURE: The patient was brought to the operating room and placed in the supine position. Following smooth induction of general anesthesia, a left-sided double-lumen endotracheal tube was placed. Position was confirmed. A Foley catheter was placed. The patent was logrolled into the left lateral decubitus position. All pressure points were appropriately padded, and the right chest was prepared and draped in the usual sterile fashion. A time-out was held confirming correct patient, correct side, and correct procedure. Preoperative antibiotics and subcutaneous heparin have been administered. A warming blanket was on the lower body.
A 5 mm port was placed in the sixth intercostal space posteriorly. This was done after infiltration with Marcaine 0.25% with epinephrine. Under the guidance of a 5 mm 30 degree scope, a 12 mm port was placed in the sixth intercostal space anteriorly and a 11 mm port was in the eighth intercostal space in the posterior axillary line. Likewise, the two port sites were infiltrated with Marcaine 0.25% with epinephrine.
The inferior pulmonary ligament was freed up. The nodule was identified in the lateral basilar segment of the right lower lobe of the lung. It was wedged out with serial firings of a GIA stapler and placed into a specimen bag and brought out through the anterior port site. The specimen was sent to pathology. Frozen section revealed a metastatic sarcoma consistent with uterine primary.
Frozen section of bronchial margins was negative. The staple lines were inspected and were hemostatic. They were treated topically with 2 mL of Tisseel fibrin sealant. Under the guidance of 30 degree scope, intercostal blocks of the right fifth, sixth, seventh, and eighth intercostal spaces were performed with an initial 15 mL of Marcaine 0.25% with epinephrine.
A 10 French chest tube was placed through a separate small stab wound incision and the sixth intercostal space anteriorly and advanced to the posterior apex of the chest. This was secured to the skin with a #2 silk suture.
The right lung was ventilated and appropriately expanded to fill the right chest. The ports were removed, and the port sites were closed in layers with absorbable suture. The skin was approximated with a 4-0 Monocryl subcuticular skin stitch. The incisions were sealed with Dermabond.
The patient awoke from general anesthesia without difficulty. The patient was extubated and transported to the postanesthesia care unit in satisfactory condition. Sponge and needle counts were recorded as correct at the end of the procedure.
