DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Left carotid stenosis.
POSTOPERATIVE DIAGNOSIS: Left carotid stenosis.
PROCEDURE PERFORMED: Left carotid endarterectomy.
SURGEON: John Doe, MD
COMPLICATIONS: None.
SPECIMENS: None.
DESCRIPTION OF OPERATION: The patient was intubated and placed in the supine position with his head tilted to the right. An incision was marked along the sternocleidomastoid muscle on the left side. It was prepped and draped in the usual sterile fashion. Then, an incision was made with a 10 blade scalpel and Bovie coagulator, and upon sectioning of the platysma muscle, the carotid was immediately found. The common carotid artery was dissected free and a vessel loop was passed around the common carotid. Then, the bifurcation was approached and the facial vein was dissected and cut. The external carotid and internal carotid were both identified. The external carotid was dissected free, and the vessel loop was passed around the external carotid. The superior thyroid artery was also dissected and temporarily clipped with a straight 5 mm clip.
Attention was then diverted to the internal carotid. Heparin 3000 units were given to the patient IV and then the internal carotid artery was dissected free, and a vessel loop was passed above the level of the stenosis. A clip was applied to the common carotid and to the external carotid. At this point, the clips were removed, a second vessel loop was passed around the common carotid and then the common carotid was clipped again, the external was clipped, and the internal was also clipped with a temporary clip.
The artery was opened with an 11 blade, the plaque divided with Potts scissors, and then a Sundt internal shunt was inserted. Upon insertion of the shunt, the clamps were removed from the common carotid and from the internal carotid, and the restoration of flow brought the EEG back to normal. At this point, the plaque was circumferentially dissected and was removed. At the level of the plaque, we found a blood clot which may be responsible for the numerous TIAs.
At this point, the area was irrigated with heparinized solution and then a patch graft from the bovine pericardium was sutured in place with a 6-0 Prolene. Before the patch was completely sutured, the shunt was removed. Clamps were reapplied to the common carotid and also to the internal carotid and then the clamp was removed. The stitching of the patch was completed, and before the final stitches were applied, the area was irrigated with heparinized solution.
Then, the internal carotid artery clamp was removed temporarily and then was reapplied and then the common carotid artery clamp was removed and the external carotid artery clamp was removed so that debris were flushed into the external carotid. After approximately 10 seconds, the internal carotid artery clamp was also removed. Hemostasis was achieved with the use of FloSeal and Oxycel and then the area was irrigated with antibiotic solution. A Jackson-Pratt was left in place. The incision was closed with 3-0 Vicryl suture for the platysma, 3-0 Vicryl suture for the subcutaneous tissue, and 4-0 Monocryl for subcuticular closure. Steri-Strips were applied in the skin.
