DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Bilateral interstitial lung disease.
2. Enlarged mediastinal lymph nodes.
3. Tobacco abuse.
4. Dyspnea.
POSTOPERATIVE DIAGNOSES:
1. Bilateral interstitial lung disease.
2. Enlarged mediastinal lymph nodes.
3. Tobacco abuse.
4. Dyspnea.
5. Sarcoidosis.
OPERATION PERFORMED:
1. Mediastinoscopy.
2. Mediastinal lymph node biopsy with frozen section.
3. Video-assisted bronchoscopy.
4. Lung biopsies x2 of the left upper lobe and left lower lobe with wedge resection.
SURGEON: John Doe, MD
ANESTHESIA: General.
ESTIMATED BLOOD LOSS: Minimal.
DRAINS: Two chest tubes.
FINDINGS: The patient had enlarged mediastinal lymph nodes. Those were positive for granulomatous disease compatible with sarcoidosis on frozen section. Microscopically, the lung showed micronodular changes with no other distinct abnormalities. A wedge resection of the left upper lobe was performed, and this was sent for pathology and culture, and a wedge resection of the left lower lobe was performed and this was sent for pathology.
DESCRIPTION OF OPERATION: The patient was taken to the operating room and placed on the operating table in a supine position and support lines were placed. General anesthesia was given via endotracheal intubation. The chest and anterior neck were prepped and draped in the usual sterile fashion.
After this was performed, a transverse incision was performed approximately 2 cm above the sternal notch. This incision was taken down through skin and subcutaneous tissue and platysma. Hemostasis was achieved using Bovie cautery. After this was performed, the anterior cervical fascia was then opened at the midline, and using blunt and sharp dissection, the anterior aspect of the trachea was dissected free from its surrounding tissues. Once this was performed, a mediastinoscope was placed and mediastinoscopy was performed.
Multiple lymph nodes were found in the lower pretracheal and paratracheal area, especially on the right side. Several biopsies were taken and sent for frozen section, and the biopsies were reported as positive for granulomatous disease, possible sarcoidosis. Once this was performed, the wound was irrigated with antibiotic solution. Hemostasis was achieved. The mediastinoscope was removed, and the wound was closed in layers.
Following this, the patient was placed in the right decubitus lateral position and left chest was prepped and draped in usual sterile fashion. A small incision was performed at the fifth intercostal space with posterior axillary line, at the eight intercostal space in the mid axillary line, and the third one at the fifth intercostal space with anterior axillary line.
Thoracoscopic examination of the chest cavity was performed. After this was performed, using the endostapler device wedge, resection of the left upper lobe and the left lower lobe was performed. Once hemostasis was achieved, the specimens were sent for pathology and culture. This was performed and the rest of the cavity was examined and checked for bleeding. This was prolonged and two of the ports were removed, the anterior and the medial one, and chest tubes were placed using the previously made incisions. The lower most posterior incision was then closed in layers. The patient tolerated the procedure well, and he was transferred to the recovery room in stable condition.
