DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Left malignant pleural effusion.
POSTOPERATIVE DIAGNOSIS: Left malignant pleural effusion.
OPERATION PERFORMED: Left thoracoscopy with mechanical and talc pleurodesis.
SURGEON: John Doe, MD
ANESTHESIA: General endotracheal anesthesia.
ESTIMATED BLOOD LOSS: 100 mL.
COMPLICATIONS: None apparent.
FINDINGS: Moderate right bloody pleural effusion.
DISPOSITION: The patient was taken to the postanesthesia care unit in serious condition.
INDICATIONS FOR OPERATION: The patient is a (XX)-year-old man with recently diagnosed adenocarcinoma of the lung with a left sided malignant pleural effusion. The patient had recurrent effusion despite thoracentesis. In addition, he has suffered pulmonary emboli. After treatment of heparin for his pulmonary embolus and placement of an IVC filter, the patient was counseled on the risks, benefits, and alternatives to a left thoracoscopy with pleurodesis to help manage his malignant pleural effusion, and informed consent was obtained.
DESCRIPTION OF OPERATION: The patient was brought to the operating room and placed in the supine position. Following smooth induction of general endotracheal anesthesia, a Foley catheter was placed. He was log rolled into the right lateral decubitus position, and all pressure points were appropriately padded, and his left chest was prepped and draped in the usual sterile fashion. A time-out was taken to confirm the correct patient and correct site for the procedure.
A 12 mm port was placed in the sixth intercostal space in the anterior axillary line after infiltrating with Marcaine 0.25% with epinephrine. There were some loose adhesions, which were taken down using the 5 mm scope and a laparoscopic Kitner to break up the adhesions. Under the guidance of a 10 mm 30-degree scope, an 11 mm port was placed in the eighth intercostal space in the mid axillary line. Again, this site was infiltrated with Marcaine 0.25% with epinephrine. Approximately 1 liter of bloody fluid was aspirated from the right breast. Mechanical abrasion of the entire parietal pleura was performed using a piece of Bovie scratch pad on laparoscopic ring forceps.
Next, a total of 3 g of sterile talc powder was insufflated with attention paid to applying it to the posterior and diaphragmatic surfaces of the pleura. Prior to the talc insufflation, portions of the parietal pleura were sent for permanent pathology evaluation. A 24 French Blake channel drain was then placed through the eighth intercostal space port site and advanced posteriorly to the apex of the chest in a dependent fashion. It was secured to the skin with interrupted 2-0 silk suture.
The port sites were closed in layers with absorbable suture with the skin approximated with a 4-0 Monocryl subcuticular stitch. The incisions were sealed with Dermabond. The patient awoke from general anesthesia. He was extubated and transported to the postanesthesia care unit in serious condition.
