Sample Report Left Chamberlain Procedure
Title of Procedure
1. Left Chamberlain procedure.
2. Right video-assisted thoracoscopic surgery.
3. Segmental resection of right upper lobe pulmonary nodule.
Procedure in Detail: After adequate general anesthesia and double-lumen endotracheal intubation, the patient was placed in the supine position. The chest was prepped and draped in the standard sterile surgical fashion. The left anterior chest wall incision was made above the second intercostal space. The incision was carried down through the subcutaneous tissues to the thoracic muscle fibers, which were divided. The intercostal muscle was divided above the edges of the second rib. The second rib was dissected from the surrounding tissue by elevating the periosteum. The second rib was then excised at its junction with the sternum and as far as two inches laterally. Retracting the lung laterally and performing blunt dissection exposed the aortopulmonary window. No evidence of nodes was seen or palpated at the aortopulmonary window. A small hole was made into the left pleura.
The decision was made at this time to complete the Chamberlain procedure by closing the pectoralis fascia in layers. Because of violation of the left pleura, a catheter was introduced into the left chest and left in place. The pectoralis fascia was closed using a running #0 PDS suture. Prior to tying the PDS suture, the anesthetist was asked to inflate the lung, and suction was applied over the catheter. The catheter was then pulled out. The suture was tied down carefully. The skin was then closed using running #3—0 Vicryl suture in a subcuticular fashion. Steri-Strips were applied over the incisions.
The patient was then positioned in the left lateral decubitus position, with the right chest upward. The right chest wall was prepped and draped in the standard sterile surgical fashion. A small incision was made at the fourth intercostal space along the midaxillary line. The incision was carried down using Bovie electrocoagulation through the intercostal muscle.
The anesthesia service was asked to drop the right lung prior to entering the chest. The right chest was entered. A 5-mm trocar was introduced into the chest followed by a 30-degree angle video camera. No evidence of adhesion was noticed in the lung. The lung was examined carefully. There was no evidence of obvious masses in the upper lobe, middle lobe or lower lobe. Another small incision was made in the fourth intercostal space anteriorly, as well as another incision in the fourth intercostal space posteriorly. The lung was then retracted using sponge forceps and manual palpation of the right upper lobe. There was a 1 × 1-cm hard mass, which was in the lower first of the right upper lobe. The mass was wedged off using multiple lobes of the GIA 30 stapler. The mass was retrieved from the chest cavity using Endobag and submitted for frozen section. Frozen section revealed no evidence of malignancy. Fibrosis, as well as histiocyte cells, was noticed. The exact diagnosis was deferred to the permanent sections.
The chest cavity at this point was irrigated with warm water and inspected for air leaks. No evidence of obvious air leak or bleeding. A size #28 chest tube was placed through the port in the midaxillary line, directed toward the apex. A size 36 French tube was placed through the anterior chest incision and exited anteriorly toward the apex. The chest tube was secured to the skin using #2—0 Surgilon suture. Both chest tubes were connected to a Pleur-evac. The posterior incision was closed using #2—0 Vicryl for the intercostal muscles and #3—0 Vicryl suture in a subcuticular fashion for the skin. Applying surgical dressings over the chest tube sites completed the procedure. The patient was then positioned in the supine position and extubated in the operating room without difficulty.
1. Left Chamberlain procedure.
2. Right video-assisted thoracoscopic surgery.
3. Segmental resection of right upper lobe pulmonary nodule.
Procedure in Detail: After adequate general anesthesia and double-lumen endotracheal intubation, the patient was placed in the supine position. The chest was prepped and draped in the standard sterile surgical fashion. The left anterior chest wall incision was made above the second intercostal space. The incision was carried down through the subcutaneous tissues to the thoracic muscle fibers, which were divided. The intercostal muscle was divided above the edges of the second rib. The second rib was dissected from the surrounding tissue by elevating the periosteum. The second rib was then excised at its junction with the sternum and as far as two inches laterally. Retracting the lung laterally and performing blunt dissection exposed the aortopulmonary window. No evidence of nodes was seen or palpated at the aortopulmonary window. A small hole was made into the left pleura.
The decision was made at this time to complete the Chamberlain procedure by closing the pectoralis fascia in layers. Because of violation of the left pleura, a catheter was introduced into the left chest and left in place. The pectoralis fascia was closed using a running #0 PDS suture. Prior to tying the PDS suture, the anesthetist was asked to inflate the lung, and suction was applied over the catheter. The catheter was then pulled out. The suture was tied down carefully. The skin was then closed using running #3—0 Vicryl suture in a subcuticular fashion. Steri-Strips were applied over the incisions.
The patient was then positioned in the left lateral decubitus position, with the right chest upward. The right chest wall was prepped and draped in the standard sterile surgical fashion. A small incision was made at the fourth intercostal space along the midaxillary line. The incision was carried down using Bovie electrocoagulation through the intercostal muscle.
The anesthesia service was asked to drop the right lung prior to entering the chest. The right chest was entered. A 5-mm trocar was introduced into the chest followed by a 30-degree angle video camera. No evidence of adhesion was noticed in the lung. The lung was examined carefully. There was no evidence of obvious masses in the upper lobe, middle lobe or lower lobe. Another small incision was made in the fourth intercostal space anteriorly, as well as another incision in the fourth intercostal space posteriorly. The lung was then retracted using sponge forceps and manual palpation of the right upper lobe. There was a 1 × 1-cm hard mass, which was in the lower first of the right upper lobe. The mass was wedged off using multiple lobes of the GIA 30 stapler. The mass was retrieved from the chest cavity using Endobag and submitted for frozen section. Frozen section revealed no evidence of malignancy. Fibrosis, as well as histiocyte cells, was noticed. The exact diagnosis was deferred to the permanent sections.
The chest cavity at this point was irrigated with warm water and inspected for air leaks. No evidence of obvious air leak or bleeding. A size #28 chest tube was placed through the port in the midaxillary line, directed toward the apex. A size 36 French tube was placed through the anterior chest incision and exited anteriorly toward the apex. The chest tube was secured to the skin using #2—0 Surgilon suture. Both chest tubes were connected to a Pleur-evac. The posterior incision was closed using #2—0 Vicryl for the intercostal muscles and #3—0 Vicryl suture in a subcuticular fashion for the skin. Applying surgical dressings over the chest tube sites completed the procedure. The patient was then positioned in the supine position and extubated in the operating room without difficulty.