DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Laryngeal cancer.
POSTOPERATIVE DIAGNOSIS: Laryngeal cancer.
OPERATIONS PERFORMED:
1. Total laryngectomy.
2. Bilateral neck dissection, levels I, II, III and IV.
3. Cricopharyngeal myotomy.
4. Total pharyngoscopy and esophagoscopy.
SURGEON: John Doe, MD
ANESTHESIA: General.
DESCRIPTION OF OPERATION: The patient was brought to the operating room and placed in the supine position. General endotracheal anesthesia was administered. All pressure points were carefully padded. The oral cavity was entered with Dedo-type laryngoscope, which was used to inspect the oropharynx, hypopharynx, and larynx. The mass was noted to involve the infrahyoid epiglottis, extending to the true vocal cords.
Following this, an esophagoscope was used to atraumatically inspect the cervical esophagus. No mass lesion was noted. Following this, fibrofatty tissue in levels II, III, and IV were dissected from the sternocleidomastoid muscle by unwrapping the muscle from its fascia. The eleventh nerve was found in its normal anatomic position. Dissection was carried posteriorly to the cervical rootlets, where dissection was carried deeply to the deep cervical fascia and anteriorly to the carotid artery, jugular vein, hypoglossal nerve and vagus nerve, which were preserved. The vagus nerve and brachial plexus were also preserved. This was done on the left and the right, completing a neck dissection at levels II, III and IV.
Following this, the tracheoesophageal grooves were carefully delineated, separating the carotid from the larynx. The superior laryngeal nerve, artery, and vein were ligated, and the hyoid bone was skeletonized. Strap muscles were transected. The entire thyroid was resected in continuity with the specimen, with care taken to preserve fibrofatty tissue and the parathyroids, which were lateralized. The larynx was entered at the vallecula, and this was inspected and found to be free of tumor. The epiglottis was retracted and cuts around the larynx freed it enough to visualize the tumors. Cuts in the piriform preserved the majority of the piriform mucosa. Dissection along the postcricoid region into the avascular plane between the trachea and esophagus resected the larynx. The tumor was carefully inspected and a wide margin was noted around it. Margins from the edges of the wound were sent for frozen section and found to be negative.
Next, the cricopharyngeal myotomy was performed on the left. Tracheoesophageal was punctured through which a Foley catheter was placed. Following this, the wound was thoroughly irrigated and hemostased. Suction drains were placed. The pharyngotomy was closed using 3-0 Vicryl in interrupted fashion with a mucosa-inverting stitch. This was done in a straight vertical closure. Following this, the platysma was closed using 3-0 Vicryl. The stoma was matured using Monocryl, and skin closure was achieved using monofilament suture. The patient tolerated the procedure well and was taken to the intensive care unit in stable condition.
