DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Left hilar and mediastinal lung mass.
POSTOPERATIVE DIAGNOSIS: Left hilar and mediastinal lung mass.
OPERATION PERFORMED: Mediastinoscopy and left Chamberlain procedure with biopsy of hilar mass.
SURGEON: John Doe, MD
ANESTHESIA: General endotracheal.
COMPLICATIONS: None.
DRAINS: One 19 French Blake drain.
FINDINGS: Frozen section was positive for carcinoma favoring small cell lung carcinoma; although, we have to wait for the final pathology report.
DESCRIPTION OF OPERATION: The patient was identified and placed on the operating table in the supine position. General endotracheal anesthesia was induced. The chest and neck were prepped and draped in the normal sterile fashion. The patient was given IV antibiotics prior to the start of the case.
A standard mediastinoscopy incision was made and dissection was carried down through the level of the strap muscles. We divided the strap muscles in the midline and then introduced the mediastinoscope along the pretracheal plane. We identified some very thick tissue in this area that appeared abnormal. We biopsied this tissue, which turned out to be thyroid tissue. We then dissected down deeper down below the level of the aorta, and we identified some abnormal tissue; however, it was very difficult to biopsy due to the depth of the mediastinoscope and the visibility was poor. The biopsies did note that there was some evidence of carcinoma; although, there is crush artifact, and they were unable to identify any specific cell type.
The decision therefore was made, due to the difficulty with the biopsies, to abort this approach and to go through a Chamberlain procedure. We then proceeded to irrigate the mediastinoscopy port out and suction until clear. We then obtained meticulous hemostasis with Bovie cautery. We assured everything was okay. We then closed the wound in two layers using absorbable stitches. The wound was injected with 0.25% Marcaine. The wounds were then cleaned and dried, and we completed a Chamberlain procedure through the second interspace on the left, making a 2.5 cm incision and dissecting down through into the left chest. We then entered the second interspace, pushed the lung out of the way and identified the mediastinum.
We then found the hilar mass and biopsied this several times with the biopsy forceps. Once this was biopsied, then we sent this to pathology for frozen section and routine evaluation. The frozen section was positive for lung carcinoma favoring small cell carcinoma; although, we need to check stains on this to obtain the final reports. We then obtained meticulous hemostasis using Surgicel and FloSeal. When we assured there was no bleeding, we then placed 19 French Blake drain along the medial aspect of the lung and then closed. We injected the wound with 0.25% Marcaine and then we closed the wound in three layers using absorbable stitches. The wounds were cleaned and dried and sterile bandages were placed. All needle, sponge, and instrument counts were correct at the end of the case. The patient tolerated the procedure well.
