DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Persistent air leak following right lower lobe lobectomy.
POSTOPERATIVE DIAGNOSIS: Persistent air leak following right lower lobe lobectomy.
PROCEDURE PERFORMED: VATS pleurodesis.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, MD
INDICATION FOR PROCEDURE: The patient is a (XX)-year-old gentleman who underwent open right lower lobectomy for his lymphoid neoplasm. His postoperative course was complicated by persistent air leak requiring placement of a Heimlich valve. The patient was ultimately discharged to home; however, he represented with a recurrent pneumothorax and persistent air leak. The patient was admitted to the hospital and placed on suction; however, this air leak and pneumothorax did not resolve. He did undergo bedside pleurodesis without resolution of his air leak. He thus was taken to the operating room for thorascopic exploration and pleurodesis.
DESCRIPTION OF PROCEDURE: The patient was placed supine on the operating room table. After adequate general dual lumen endotracheal anesthesia, the patient was turned on his left side. His right chest was prepped and draped in a standard surgical fashion. After establishment of single-lung ventilation, a Veress needle was introduced posteriorly along the seventh intercostal space. The thoracic cavity was then insufflated without complications.
An incision was made along the posterior aspect of the seventh intercostal space, and a 10 mm trocar was introduced into the thoracic cavity without difficulty. A camera was then inserted, and the patient’s lung was noted to be fully deflated, and no adhesions were noted. A second 10 mm trocar was placed anteriorly along the seventh intercostal space. The lung was then retracted, and the staple line and bronchial stump were examined. No obvious injuries or areas of suspicion were identified along the bronchial stump or previous staple line.
The chest was then filled with saline, and the lung was then carefully re-expanded. There was no evidence of leaking from the bronchial stump or from the staple line. The lung was then deflated again, and the chest was then filled with saline and the lung was submerged. The lung was then carefully re-expanded, and an area of leaking was noted along the lateral border of the upper lobe. It appeared to be along the line of the previous chest tube. No other leaks were identified. The lung was then deflated, and the chest was then drained. The lung parenchyma was then sealed with CoSeal.
A mechanical pleurodesis was then performed using ring forceps and Bovie scratch pad. A 24-French chest tube was then placed through the posterior port site and tunneled anteriorly. The lung was then re-expanded under direct visualization, and the CoSeal was noted to remain intact.
At this point, the remaining trocar and camera were removed, and the incisions were closed in two layers with 2-0 Vicryl followed by Monocryl stitch. The chest tube was then placed to suction, and a very small intermittent air leak was noted. The patient was then returned to the supine position and allowed to awaken and was extubated without difficulty. Upon extubation, a very small intermittent air leak was noted. The patient tolerated the operation well. There were no immediate complications. The sponge, needle, and instrument counts were correct at the end of the case. The patient was taken to the recovery room in good condition.
