DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Bilateral lung nodules.
OPERATION PERFORMED: Right video-assisted thoracoscopic lung biopsy x3.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, MD
ANESTHESIA: General endotracheal anesthesia.
COMPLICATIONS: None.
DRAINS: One 32 French chest tube.
OPERATIVE FINDINGS: Frozen section was positive for metastatic adenocarcinoma.
INDICATIONS FOR OPERATION: This is a (XX)-year-old Hispanic male with a past medical history significant for rectal cancer, status post resection three years ago, who presented for followup and was noted to have evidence of a lung nodule on x-ray. This was followed up by CAT scan of the chest that noted multiple pulmonary nodules as well as enlarged lymph nodes. All the nodules were very small and too numerous to count but not amenable to percutaneous biopsy due to their small size. The patient presents today for thoracoscopic lung biopsy.
DESCRIPTION OF OPERATION: The patient was identified and placed on the operative table in the supine position. General endotracheal anesthesia was induced. The chest and lower extremities were prepped and draped in the normal sterile fashion. The patient was given intravenous antibiotics prior to start of the case. The patient had a dual-lumen endotracheal tube placed and was placed on independent lung ventilation utilizing just the left lung.
The patient was placed in the left lateral decubitus position, and the right lateral chest was prepped and draped in the normal sterile fashion. The patient was given intravenous antibiotics prior to start of the case. We placed three standard thoraco ports, one in the fifth interspace in the subscapular line, one in the fifth interspace in the inframammary fold, and then one in the seventh interspace in the mid axillary line. We then evaluated the chest and noted that there were several subpleural nodules that could be palpated in the upper and lower lobes near the fissure.
We then biopsied three separate positions and sent one down for frozen sectioning and the other two down for permanent sectioning. The frozen section came back as positive for adenocarcinoma. We then coated our staple lines with Tisseel. We checked for any evidence of any significant air leaks, and there was none. We then checked for any evidence of any bleeding. When we were sure that there was none, we then reinflated the lung under direct vision.
We placed a 32 French chest tube up to the apex posteriorly. We then sutured this in place. We then closed all of our thoraco ports using three layers of absorbable stitches. The wounds were all cleaned and dried, and sterile bandages were placed. All sponge, needle, and instrument counts were correct at the end of the case. The patient tolerated the procedure well and will be extubated and taken to the recovery room at the end of the case.
