Parathyroidectomy Medical Transcription Operative Sample Report
DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Primary hyperparathyroidism.
2. Osteoporosis.
POSTOPERATIVE DIAGNOSES:
1. Primary hyperparathyroidism.
2. Osteoporosis.
OPERATIONS PERFORMED:
1. Minimally invasive video-assisted parathyroidectomy.
2. Continuous laryngeal nerve integrity monitoring x3 hours.
SURGEON: John Doe, MD
ANESTHESIA: General.
ESTIMATED BLOOD LOSS: Less than 50 mL.
COMPLICATIONS: None.
OPERATIVE FINDINGS: 600 mg hypercellular left inferior parathyroid probable adenoma, grossly normal-appearing left and right superior parathyroid glands. Right inferior parathyroid gland was not localized.
INDICATIONS FOR OPERATION: This is an elderly female with severe progressive osteoporosis and primary hyperparathyroidism. After discussion of risks and benefits, including alternate treatment options, the patient elected to proceed with parathyroidectomy through a minimally invasive approach under general anesthesia. Preoperative ultrasound and sestamibi both suggested a probable left inferior parathyroid adenoma. Both imaging studies were present intraoperatively to assist with surgical localization.
DESCRIPTION OF OPERATION: The patient was brought to the operating room and placed in the supine position induced and intubated per Anesthesia. The patient was intubated with 7.0 Xomed nerve integrity monitoring endotracheal tube. Direct laryngoscopy was performed to confirm accurate placement of the EMG contact electrodes to the vocalis muscles and endolarynx bilaterally. Subdermal ground electrodes were placed. All electrodes were hooked up to the nerve monitor, which was turned on and set for continuous laryngeal nerve monitoring for the remainder of the two-hour operative procedure. Electrode impedance was confirmed. A short-acting muscle relaxant was given for intubation. No further muscle relaxant was given and no topical laryngeal anesthetic was used.
After confirming the correct patient and procedure using the standard time-out technique, a 3 cm horizontal skin incision was made through a previously identified skin crease. Dissection was carried down to the subplatysmal plane. The strap muscles were divided midline and retracted laterally on the left. The thyroid gland was mobilized medially using the 5 mm 30-degree endoscope with video assistance, and a large left inferior parathyroid was immediately identified. The recurrent laryngeal nerve was identified, its integrity confirmed with the nerve stimulator and monitor.
The left inferior parathyroid was gently dissected using blunt technique and was removed and sent for frozen histologic diagnosis, which was consistent with a 600 mg hypercellular parathyroid. Intraoperative PTH levels were sent at preincision, pre-removal and 5 and 10 minutes post removal. These came back at 170, greater than 500, 160 and 118 respectively. Due to concern for possible multigland disease, the decision was made to perform bilateral exploration.
The left superior parathyroid gland was grossly normal in appearance. The right superior parathyroid gland was likely grossly normal. The right inferior parathyroid gland could not be identified. The right recurrent laryngeal nerve integrity was preserved and confirmed using the nerve stimulator and monitor. A biopsy was performed of the right superior parathyroid gland, which was questionably hypercellular. A 30-minute post removal of the left inferior parathyroid PTH level came back at 42.
Based upon this information and the lack of second adenoma being localized, the decision was made to terminate the procedure. Hemostasis was obtained. The integrity of the recurrent nerves was confirmed bilaterally, and the wound was closed in layers over a suction drain. The patient was taken to the recovery room in good condition awake and extubated.
