The patient was met in the preoperative holding area, patient, consent, site and procedure to be performed confirmed. All questions answered. The patient was transported to the operating room and placed on the table in supine position. A safety check was performed before induction of anesthetic and all were in agreement of patient and procedure and side. General anesthesia was induced the patient was intubated with a double-lumen ET tube. Bronchoscopy confirmed appropriate position of the tube and did not show any evidence of disease in the [] bronchi. The patient was placed in the [right/left] lateral decubitus secured with straps, [beanbag/anterior and posterior pads] and all bony prominences padded. Bronchoscopy was again performed confirming appropriate location of the double lumen ET tube.
The [left/right] chest was prepped including the marker placed by the interventional radiologists, allowed appropriate time to dry and draped in normal sterile fashion. Timeout was done confirming patient, procedure, equipment, imaging, allergies and all were in agreement. The anesthesia team began single lung ventilation. The first incision was made along the mid axillary line approximately [number] rib space. This was carried down through the muscle layer and the pleural cavity was entered bluntly. A second port was placed along the anteriorly at the level of the [rib number] rib space under direct visulaization. Upon entering the pleural cavity it was noted that [findings]. CT guided marker string was visible in the [lobe].
The [lobe] at the location of the CT-guided marker was grasped and retracted and compression clamp was placed. Next the wedge resection was performed using sequential endogia staple loads. The specimen was divided from the remaining lung and the staple line and was noted to be hemostatic. The specimen was removed in a bag. The [nodule/marker/both nodule and marker] were palpated.
Attention was turned to the inferior pulmonary ligament. This was released with electrocautery to the level of the inferior pulmonary vein. Level 9 lymph nodes were sampled and sent for permanent pathology.
[other nodal station dictation]
Posterior rib blocks were performed with Ropivacaine.
Attention was turned to the port sites. Hemostasis was achieved with electrocautery. A [size] French chest tube was placed through the mid axillary line port and positioned superior to the lung to the apex of the thorax. The lung was inflated completely under direct visualization. The anesthesiologist did not note any air leak. The chest tube was connected to the atrium and to suction. A 2-0 Vicryl u-stitch was placed around the chest tube at the muscle layer. The chest tube was secured to the skin with 0 Ethibond.
The anterior port was closed at the muscular layer with 2-0 Vicryl figure-of-eight stitch and at the deep dermal layer with buried interrupted 2-0 Vicryl. The skin was closed with running 4-0 Monocryl and Dermabond. Chest tube dressing was applied. All counts were noted to be correct. The patient was liberated from anesthesia uneventfully and transported the PACU in stable condition. Postoperative PACU chest x-ray with was ordered.
Service: Thoracic
Author: Garrett Skinner