DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Cerebral palsy, spasticity, discomfort at the pump site.
POSTOPERATIVE DIAGNOSIS: Cerebral palsy, spasticity, discomfort at the pump site.
OPERATIONS PERFORMED:
1. Removal of the intrathecal pump.
2. Removal of the intrathecal catheter.
SURGEON: John Doe, MD
ANESTHESIA: General.
DRAINS: None.
SPECIMENS: None.
IMPLANTS: None.
EXPLANTS: The entire intrathecal drug infusion system.
BLOOD LOSS: Minimal.
COMPLICATIONS: None.
DESCRIPTION OF OPERATION: Once the appropriate informed consents were obtained from the patient, the patient was taken to the operating room where anesthesia was induced, and the patient was intubated using laryngeal mask. The patient was placed in lateral position with her left side up, and her body was padded appropriately. She was secured with a beanbag and then the old incisions over the left side of the abdomen and over the upper lumbar area were marked. The patient’s lumbar region and the left side of the abdomen were prepped and draped in standard sterile fashion, and then after application of local anesthetic, first incision was made over the old scar in the patient’s abdominal wall. The dissection of the soft tissues allowed us to expose the pump that was wrapped in a Dacron pouch, and once we cut the string of that pouch, we were able to mobilize the pump and take it out of the pocket. The catheter was cut a few centimeters away from the pump and then the pump was removed from the patient and discarded.
A second incision was made over the old scar in the lumbar area. Here, we dissected the soft tissues, and once the anchor holding the catheter in place was identified, the suture holding the anchor was cut and then the catheter was gently pulled out of the patient’s spine. We confirmed that the catheter was completely removed from the spinal canal and then we also removed the subcutaneous part of the catheter that was traveling towards the abdomen. Once the pump and anchor were removed, they were discarded and then we placed an S-shaped Ethibond suture over the catheter insertion site to stop the CSF leak over that area. Once the suture was tied, there was no evidence of ongoing CSF leakage, and therefore, the incisions were irrigated with a large amount of bacitracin solution and closed in layers. We decided to leave alone the pouch in which the pump was secured in order to minimize the amount of bleeding from the soft tissues, particularly since the pouch itself did not appear to irritate the patient during the years of life with pump.
Once the incisions were closed, the skin was approximated and closed with running subcuticular 4-0 Vicryl and then the soft tissues and the lumbar incision were closed with nylon. Both incisions were covered with sterile dressing and then the patient was transferred onto the cart, awakened from anesthesia and extubated uneventfully. She was brought to the recovery room in stable condition. There were no complications during the surgery. The patient tolerated the procedure well. The counts of needles, instruments, and sponges were all reported as correct.
