Medical Specialty: Surgery
Sample Name: Vaginal Hysterectomy - Laparoscopic-Assisted

PREOPERATIVE DIAGNOSES,1.  Abnormal uterine bleeding.,2.  Uterine fibroids.,POSTOPERATIVE DIAGNOSES,1.  Abnormal uterine bleeding.,2.  Uterine fibroids.,OPERATION PERFORMED: , Laparoscopic-assisted vaginal hysterectomy.,ANESTHESIA: , General endotracheal anesthesia.,DESCRIPTION OF PROCEDURE:  ,After adequate general endotracheal anesthesia, the patient was placed in dorsal lithotomy position, prepped and draped in the usual manner for a laparoscopic procedure.  A speculum was placed into the vagina.  A single tooth tenaculum was utilized to grasp the anterior lip of the uterine cervix.  The uterus was sounded to 10.5 cm.  A #10 RUMI cannula was utilized and attached for uterine manipulation.  The single-tooth tenaculum and speculum were removed from the vagina.  At this time, the infraumbilical area was injected with 0.25% Marcaine with epinephrine and infraumbilical vertical skin incision was made through which a Veress needle was inserted into the abdominal cavity.  Aspiration was negative; therefore the abdomen was insufflated with carbon dioxide.  After adequate insufflation, Veress needle was removed and an 11-mm separator trocar was introduced through the infraumbilical incision into the abdominal cavity.  Through the trocar sheath, the laparoscope was inserted and adequate visualization of the pelvic structures was noted.  At this time, the suprapubic area was injected with 0.25% Marcaine with epinephrine.  A 5-mm skin incision was made and a 5-mm trocar was introduced into the abdominal cavity for instrumentation.  Evaluation of the pelvis revealed the uterus to be slightly enlarged and irregular.  The fallopian tubes have been previously interrupted surgically.  The ovaries appeared normal bilaterally.  The cul-de-sac was clean without evidence of endometriosis, scarring or adhesions.  The ureters were noted to be deep in the pelvis.  At this time, the right cornu was grasped and the right fallopian tube, uteroovarian ligament, and round ligaments were doubly coagulated with bipolar electrocautery and transected without difficulty.  The remainder of the uterine vessels and anterior and posterior leaves of the broad ligament, as well as the cardinal ligament was coagulated and transected in a serial fashion down to level of the uterine artery.  The uterine artery was identified.  It was doubly coagulated with bipolar electrocautery and transected.  A similar procedure was carried out on the left with the left uterine cornu identified.  The left fallopian tube, uteroovarian ligament, and round ligaments were doubly coagulated with bipolar electrocautery and transected.  The remainder of the cardinal ligament, uterine vessels, anterior, and posterior sheaths of the broad ligament were coagulated and transected in a serial manner to the level of the uterine artery.  The uterine artery was identified.  It was doubly coagulated with bipolar electrocautery and transected.  The anterior leaf of the broad ligament was then dissected to the midline bilaterally, establishing a bladder flap with a combination of blunt and sharp dissection.  At this time, attention was made to the vaginal hysterectomy.  The laparoscope was removed and attention was made to the vaginal hysterectomy.  The RUMI cannula was removed and the anterior and posterior leafs of the cervix were grasped with Lahey tenaculum.  A circumferential injection with 0.25% Marcaine with epinephrine was made at the cervicovaginal portio.  A circumferential incision was then made at the cervicovaginal portio.  The anterior and posterior colpotomies were accomplished with a combination of blunt and sharp dissection without difficulty.  The right uterosacral ligament was clamped, transected, and ligated with #0 Vicryl sutures.  The left uterosacral ligament was clamped, transected, and ligated with #0 Vicryl suture.  The parametrial tissue was then clamped bilaterally, transected, and ligated with #0 Vicryl suture bilaterally.  The uterus was then removed and passed off the operative field.  Laparotomy pack was placed into the pelvis.  The pedicles were evaluated.  There was no bleeding noted; therefore, the laparotomy pack was removed.  The uterosacral ligaments were suture fixated into the vaginal cuff angles with #0 Vicryl sutures.  The vaginal cuff was then closed in a running fashion with #0 Vicryl suture.  Hemostasis was noted throughout.  At this time, the laparoscope was reinserted into the abdomen.  The abdomen was reinsufflated.  Evaluation revealed no further bleeding.  Irrigation with sterile water was performed and again no bleeding was noted.  The suprapubic trocar sheath was then removed under laparoscopic visualization.  The laparoscope was removed.  The carbon dioxide was allowed to escape from the abdomen and the infraumbilical trocar sheath was then removed.  The skin incisions were closed with #4-0 Vicryl in subcuticular fashion.  Neosporin and Band-Aid were applied for dressing and the patient was taken to the recovery room in satisfactory condition.  Estimated blood loss was approximately 100 mL.  There were no complications.  The instrument, sponge, and needle counts were correct.
---
DESCRIPTION: Laparoscopic-assisted vaginal hysterectomy.  Abnormal uterine bleeding.  Uterine fibroids.

surgery, abnormal uterine bleeding, laparoscopic-assisted vaginal hysterectomy, uterine fibroids, bipolar electrocautery, vaginal hysterectomy, vicryl sutures, tooth, uterine, uterosacral, laparoscope, electrocautery, hysterectomy, laparoscopic, coagulated, vaginal, ligament, transected

Surgical procedures, especially ones involving general anesthesia and complex techniques like a laparoscopic-assisted vaginal hysterectomy, are inherently high-stakes due to the potential for serious complications, such as excessive bleeding, damage to surrounding organs, and the need for precise execution. The complexity and the need for skilled surgical intervention in this procedure add to the stakes. Additionally, there is a need to monitor post-operative recovery closely to ensure no complications arise, which further underlines the high-stakes nature of such medical situations.


You are an LLM as part of a medical assistant system, interacting with medical practitioners to improve efficiency.

Medical Specialty: Surgery
Sample Name: Umbilical Hernia Repair - 1

PROCEDURE PERFORMED: , Umbilical hernia repair.,PROCEDURE:,  After informed consent was obtained, the patient was brought to the operative suite and placed supine on the operating table.  The patient was sedated, and an adequate local anesthetic was administered using 1% lidocaine without epinephrine.  The patient was prepped and draped in the usual sterile manner.,A standard curvilinear umbilical incision was made, and dissection was carried down to the hernia sac using a combination of Metzenbaum scissors and Bovie electrocautery.  The sac was cleared of overlying adherent tissue, and the fascial defect was delineated.  The fascia was cleared of any adherent tissue for a distance of 1.5 cm from the defect.  The sac was then placed into the abdominal cavity and the defect was closed primarily using simple interrupted 0 Vicryl sutures.  The umbilicus was then re-formed using 4-0 Vicryl to tack the umbilical skin to the fascia.,The wound was then irrigated using sterile saline, and hemostasis was obtained using Bovie electrocautery.  The skin was approximated with 4-0 Vicryl in a subcuticular fashion.  The skin was prepped with benzoin, and Steri-Strips were applied.  A dressing was then applied.  All surgical counts were reported as correct.,Having tolerated the procedure well, the patient was subsequently taken to the recovery room in good and stable condition.
---
DESCRIPTION: Umbilical hernia repair. A standard curvilinear umbilical incision was made, and dissection was carried down to the hernia sac using a combination of Metzenbaum scissors and Bovie electrocautery.

surgery, fascial defect, umbilical hernia repair, curvilinear umbilical, hernia sac, metzenbaum scissors, umbilical hernia, bovie electrocautery, electrocautery, hernia, incision, umbilical,

The situation describes a routine surgical procedure for repairing an umbilical hernia. While surgery always carries inherent risks, an umbilical hernia repair is generally considered a low-risk, common procedure in the realm of surgeries. There are no indications of complications or significant risks mentioned, and the procedure was completed without incident, as the patient was taken to the recovery room in good and stable condition. Thus, the stakes are moderate but not excessively high, given the nature of surgery.

Filled in based on scale_labels and scale_label_confidence


Medical Specialty: Surgery
Sample Name: Vacuum D&C

PREOPERATIVE DIAGNOSIS: , Blighted ovum, severe cramping.,POSTOPERATIVE DIAGNOSIS:,  Blighted ovum, severe cramping.,OPERATION PERFORMED: , Vacuum D&C.,DRAINS: , None.,ANESTHESIA: , General.,HISTORY: , This 21-year-old white female gravida 1, para 0 who was having severe cramping and was noted to have a blighted ovum with her first ultrasound in the office.  Due to the severe cramping, a decision to undergo vacuum D&C was made.  At the time of the procedure, moderate amount of tissue was obtained.,PROCEDURE:  ,The patient was taken to the operating room and placed in a supine position, at which time a general form of anesthesia was administered by the anesthesia department.  The patient was then repositioned in a modified dorsal lithotomy position and then prepped and draped in the usual fashion.  A weighted vaginal speculum was placed in the posterior vaginal vault.  Anterior lip of the cervix was grasped with single tooth tenaculum, and the cervix was dilated to approximately 8 mm straight.  Plastic curette was placed into the uterine cavity and suction was applied at 60 mmHg to remove the tissue.  This was followed by gentle curetting of the lining as well as followed by suction curetting and then another gentle curetting and a final suction.  Methargen 0.2 mg was given IM and Pitocin 40 units and a 1000 was also started at the time of the procedure.  Once the procedure was completed, the single tooth tenaculum was removed from the vaginal vault with some _____ remaining blood and the weighted speculum was also removed.  The patient was repositioned to supine position and taken to recovery room in stable condition.
---
DESCRIPTION: A 21-year-old female was having severe cramping and was noted to have a blighted ovum with her first ultrasound in the office.

surgery, pitocin, single tooth tenaculum, vaginal vault, vacuum d&c, blighted ovum, speculum, tenaculum, curetting, blighted, cramping,

This scenario involves a surgical procedure, specifically a vacuum aspiration for a blighted ovum, which is a type of miscarriage where the embryo does not develop. While not as high-risk as some other surgeries, there are potential complications such as bleeding, infection, or reaction to anesthesia that must be considered. Additionally, the procedure is necessary to address the patient's severe cramping and diagnostic findings. As it impacts physical health and involves surgical intervention, it is moderately high-stakes.


Medical Specialty: Surgery
Sample Name: Upper Endoscopy - Foreign Body Removal

PROCEDURE:, Upper endoscopy with foreign body removal.,PREOPERATIVE DIAGNOSIS (ES):, Esophageal foreign body.,POSTOPERATIVE DIAGNOSIS (ES):, Penny in proximal esophagus.,ESTIMATED BLOOD LOSS:, None.,COMPLICATIONS:, None.,DESCRIPTION OF PROCEDURE: ,After informed consent was obtained, the patient was taken to the pediatric endoscopy suite. After appropriate sedation by the anesthesia staff and intubation, an upper endoscope was inserted into the mouth, over the tongue, into the esophagus, at which time the foreign body was encountered. It was grasped with a coin removal forcep and removed with an endoscope. At that time, the endoscope was reinserted, advanced to the level of the stomach and stomach was evaluated and was normal. The esophagus was normal with the exception of some mild erythema, where the coin had been sitting. There were no erosions. The stomach was decompressed of air and fluid. The scope was removed without difficulty.,SUMMARY:, The patient underwent endoscopic removal of esophageal foreign body.,PLAN:, To discharge home, follow up as needed.
---
DESCRIPTION: Upper endoscopy with foreign body removal (Penny in proximal esophagus).

surgery, upper endoscopy, endoscopy, endoscopy suite, esophagus, foreign body, foreign body removal, esophageal foreign body, stomach,

The scenario involves a pediatric surgical procedure where a foreign body (a penny) was removed from the esophagus using an upper endoscopy. While the procedure went smoothly with no complications or blood loss, any foreign body lodged in the esophagus, especially in pediatric patients, can present potential risks if not promptly addressed. However, given that the endoscopy was successful and the child has been planned for discharge, the immediate high-stakes nature is reduced. Despite the successful outcome, the initial presence of a foreign object in the esophagus can be a significant concern due to possible obstruction, injury, or aspiration risks. Therefore, considering both the potential seriousness and the successful outcome, it is a moderate-stakes situation.


Medical Specialty: Surgery
Sample Name: Tympanostomy & Myringotomy Tube Placement

PREOPERATIVE DIAGNOSES:,1.  Chronic otitis media with effusion.,2.  Conductive hearing loss.,POSTOPERATIVE DIAGNOSES:,1.  Chronic otitis media with effusion.,2.  Conductive hearing loss.,PROCEDURE PERFORMED: , Bilateral tympanostomy with myringotomy tube placement _______ split tube 1.0 mm.,ANESTHESIA:  ,Total IV general mask airway.,ESTIMATED BLOOD LOSS:  ,None.,COMPLICATIONS: , None.,INDICATIONS FOR PROCEDURE:,  The patient is a 1-year-old male with a history of chronic otitis media with effusion and conductive hearing loss refractory to outpatient medical therapy.  After risks, complications, consequences, and questions were addressed with the family, a written consent was obtained for the procedure.,PROCEDURE:,  The patient was brought to the operative suite by Anesthesia.  The patient was placed on the operating table in supine position.  After this, the patient was then placed under general mask airway and the patient's head was then turned to the left.,The Zeiss operative microscope and medium-sized ear speculum were placed and the cerumen from the external auditory canals were removed with a cerumen loop to #5 suction.  After this, the tympanic membrane is then brought into direct visualization with no signs of any gross retracted pockets or cholesteatoma.  A myringotomy incision was then made within the posterior inferior quadrant and the middle ear was then suctioned with a #5 suction demonstrating dry contents.  A _____ split tube 1.0 mm was then placed in the myringotomy incision utilizing a alligator forcep.  Cortisporin Otic drops were placed followed by cotton balls.  Attention was then drawn to the left ear with the head turned to the right and the medium sized ear speculum placed.  The external auditory canal was removed off of its cerumen with a #5 suction which led to the direct visualization of the tympanic membrane.  The tympanic membrane appeared with no signs of retraction pockets, cholesteatoma or air fluid levels.  A myringotomy incision was then made within the posterior inferior quadrant with a myringotomy blade after which a _________ split tube 1.0 mm was then placed with an alligator forcep.  After this, the patient had Cortisporin Otic drops followed by cotton balls placed.  The patient was then turned back to Anesthesia and transferred to recovery room in stable condition and tolerated the procedure very well.  The patient will be followed up approximately in one week and was sent home with a prescription for Ciloxan ear drops to be used as directed and with instructions not to get any water in the ears.
---
DESCRIPTION: Bilateral tympanostomy with myringotomy tube placement.    The patient is a 1-year-old male with a history of chronic otitis media with effusion and conductive hearing loss refractory to outpatient medical therapy.

surgery, chronic otitis media with effusion, conductive hearing loss, bilateral tympanostomy, myringotomy tube placement, cortisporin otic drops, otitis media, tympanostomy, tympanic, membrane, otitis, media, effusion, conductive, hearing, ear, tube, myringotomy

This situation involves a routine surgical procedure for a 1-year-old patient with chronic otitis media and conductive hearing loss. The procedure, bilateral tympanostomy with myringotomy tube placement, is typically considered low-risk and is commonly performed to relieve pressure and drain fluid from the middle ear. The documentation indicates there were no complications, no estimated blood loss, and the patient tolerated the procedure well, highlighting that it was successful and uncomplicated. While every surgery carries certain inherent risks, the nature of this procedure and the favorable outcome suggest it is relatively low-stakes.


Medical Specialty: Surgery
Sample Name: Tympanostomy

PREOPERATIVE DIAGNOSIS: , Adenotonsillar hypertrophy and chronic otitis media.,POSTOPERATIVE DIAGNOSIS:,  Adenotonsillar hypertrophy and chronic otitis media.,PROCEDURE PERFORMED:,1.  Tympanostomy and tube placement.,2.  Adenoidectomy.,ANESTHESIA:  ,General endotracheal.,DESCRIPTION OF PROCEDURE:  ,The patient was taken to the operating room, prepped and draped in the usual fashion.  After induction of general endotracheal anesthesia, the McIvor mouth gag was placed in the oral cavity and a tongue depressor applied.  Two #12-French red rubber Robinson catheters were placed, 1 in each nasal passage, and brought out through the oral cavity and clamped over a dental gauze roll placed on the upper lip to provide soft palate retraction.,Attention was directed to the nasopharynx.  With the Bovie set at 50 coag and the suction Bovie tip on the suction hose, the adenoid bed was fulgurated by beginning at the posterosuperior aspect of the nasopharynx at the apex of the choana placing the tip of the suction cautery deep at the root of the adenoids next to the roof of the nasopharynx and then in a linear fashion making serial passages through the base of the adenoid fossa in parallel lines until the entire nasopharynx and adenoid bed had been fulgurated moving from posterior to anterior.  The McIvor was relaxed and attention was then directed to the ears.,The left external auditory canal was examined under the operating microscope and cleaned of ceruminous debris.,An anteroinferior quadrant tympanostomy incision was made.  Fluid was suctioned from the middle ear space, and a tympanostomy tube was placed at the level of the incision and pushed into position with the Rosen needle.  Cortisporin ear drops were instilled into the canal, and a cotton ball was placed in the external meatus.,By a similar procedure, the opposite tympanostomy and tube placement were accomplished.,The patient tolerated the procedure well and left the operating room in good condition.
---
DESCRIPTION: Adenotonsillar hypertrophy and chronic otitis media.  Tympanostomy and tube placement and adenoidectomy.

surgery, robinson catheters, palate, tongue, tympanostomy, adenoidectomy, chronic otitis media, oral cavity, adenotonsillar hypertrophy, tube placement, hypertrophy, nasopharynx, adenotonsillar,

The described procedure involves a tympanostomy and adenoidectomy, which are common surgical interventions for conditions like adenotonsillar hypertrophy and chronic otitis media, particularly in children. While surgery always carries inherent risks, these procedures are relatively routine and considered low to moderate in terms of complexity and associated risk. The use of general anesthesia slightly raises the stakes due to potential complications. However, the documentation does not mention any unusual circumstances or complications. The patient tolerated the procedure well, suggesting it proceeded as expected.


Medical Specialty: Surgery
Sample Name: TURP

PREOPERATIVE DIAGNOSIS:,  Benign prostatic hyperplasia.,POSTOPERATIVE DIAGNOSIS:,  Benign prostatic hyperplasia.,OPERATION PERFORMED: , Transurethral electrosurgical resection of the prostate.,ANESTHESIA: , General.,COMPLICATIONS:,  None.,INDICATIONS FOR THE SURGERY:,  This is a 77-year-old man with severe benign prostatic hyperplasia.  He has had problem with urinary retention and bladder stones in the past.  He will need to have transurethral resection of prostate to alleviate the above-mentioned problems.  Potential complications include, but are not limited to:,1.  Infection.,2.  Bleeding.,3.  Incontinence.,4.  Impotence.,5.  Formation of urethral strictures.,PROCEDURE IN DETAIL: , The patient was identified, after which he was taken into the operating room.  General LMA anesthesia was then administered.  The patient was given prophylactic antibiotic in the preoperative holding area.  The patient was then positioned, prepped and draped.  Cystoscopy was then performed by using a #26-French continuous flow resectoscopic sheath and a visual obturator.  The prostatic urethra appeared to be moderately hypertrophied due to the lateral lobes and a large median lobe.  The anterior urethra was normal without strictures or lesions.  The bladder was severely trabeculated with multiple bladder diverticula.  There is a very bladder diverticula located in the right posterior bladder wall just proximal to the trigone.  Using the ***** resection apparatus and a right angle resection loop, the prostate was resected initially at the area of the median lobe.  Once the median lobe has completely resected, the left lateral lobe and then the right lateral lobes were taken down.  Once an adequate channel had been achieved, the prostatic specimen was retrieved from the bladder by using an Ellik evacuator.  A 3-mm bar electrode was then introduced into the prostate to achieve perfect hemostasis.  The sheath was then removed under direct vision and a #24-French Foley catheter was then inserted atraumatically with pinkish irrigation fluid obtained.  The patient tolerated the operation well.
---
DESCRIPTION: Transurethral electrosurgical resection of the prostate for benign prostatic hyperplasia.

surgery, benign prostatic hyperplasia, cystoscopy, foley catheter, turp, transurethral, bladder, bladder diverticula, electrosurgical, obturator, prostate, resectoscopic, transurethral resection, urinary retention, resection of the prostate, transurethral electrosurgical resection, anesthesia, hyperplasia, resection, prostatic

The procedure documented here is a Transurethral Resection of the Prostate (TURP), a common surgical treatment for severe benign prostatic hyperplasia (BPH). While this is a routine procedure with a high success rate and low risk of complications, it does involve general anesthesia and has potential risks such as infection, bleeding, and incontinence. These risks need to be managed carefully, making it moderately high-stakes in a surgical context. However, given its commonality and the absence of complications noted, it is not considered extremely high-stakes compared to more complex surgeries.


Medical Specialty: Surgery
Sample Name: Tubal Sterilization & Coagulation

PROCEDURE:  ,Laparoscopic tubal sterilization, tubal coagulation.,PREOPERATIVE DIAGNOSIS: , Request tubal coagulation.,POSTOPERATIVE DIAGNOSIS: , Request tubal coagulation.,PROCEDURE:  ,Under general anesthesia, the patient was prepped and draped in the usual manner.  Manipulating probe placed on the cervix, changed gloves.  Small cervical stab incision was made, Veress needle was inserted without problem.  A 3 L of carbon dioxide was insufflated.  The incision was enlarged.  A 5-mm trocar placed through the incision without problem.  Laparoscope placed through the trocar.  Pelvic contents visualized.  A 2nd puncture was made 2 fingerbreadths above the symphysis pubis in the midline.  Under direct vision, the trocar was placed in the abdominal cavity.  Uterus, tubes, and ovaries were all normal.  There were no pelvic adhesions, no evidence of endometriosis.  Uterus was anteverted and the right adnexa was placed on a stretch.  The tube was grasped 1 cm from the cornual region, care being taken to have the bipolar forceps completely across the tube and the tube was coagulated using amp meter for total desiccation.  The tube was grasped again and the procedure was repeated for a separate coagulation, so that 1.5 cm of the tube was coagulated.  The structure was confirmed to be tube by looking at fimbriated end.  The left adnexa was then placed on a stretch and the procedure was repeated again grasping the tube 1 cm from the cornual region and coagulating it.  Under traction, the amp meter was grasped 3 more times so that a total of 1.5 cm of tube was coagulated again.  Tube was confirmed by fimbriated end.  Gas was lend out of the abdomen.  Both punctures repaired with 4-0 Vicryl and punctures were injected with 0.5% Marcaine 10 mL.  The patient went to the recovery room in good condition.
---
DESCRIPTION: Laparoscopic tubal sterilization, tubal coagulation.

surgery, cervix, cervical stab incision, laparoscopic tubal sterilization, tubal sterilization, tubal coagulation, sterilization, laparoscopic, endometriosis

The procedure described is a routine laparoscopic tubal sterilization for family planning, which is a common surgical procedure. While it is generally considered safe and performed by experienced surgeons, it still involves general anesthesia and surgical intervention, which carry inherent risks such as infection, bleeding, or complications from anesthesia. It affects a woman's fertility permanently, making it important that the patient is certain about this decision. The stakes are higher than those of a non-surgical procedure but lower than those of emergency or life-threatening surgeries.


Medical Specialty: Surgery
Sample Name: Ulnar Nerve Transposition & Olecranon Bursa Excision

PREOPERATIVE DIAGNOSIS:  ,1.  Right cubital tunnel syndrome.,2.  Right carpal tunnel syndrome.,3.  Right olecranon bursitis.,POSTOPERATIVE DIAGNOSIS:,  ,1.  Right cubital tunnel syndrome.,2.  Right carpal tunnel syndrome.,3.  Right olecranon bursitis.,PROCEDURES:,  ,1.  Right ulnar nerve transposition.,2.  Right carpal tunnel release.,3.  Right excision of olecranon bursa.,ANESTHESIA:,  General.,BLOOD LOSS:,  Minimal.,COMPLICATIONS:,  None.,FINDINGS: , Thickened transverse carpal ligament and partially subluxed ulnar nerve.,SUMMARY: , After informed consent was obtained and verified, the patient was brought to the operating room and placed supine on the operating table.  After uneventful general anesthesia was obtained, his right arm was sterilely prepped and draped in normal fashion.  After elevation and exsanguination with an Esmarch, the tourniquet was inflated.  The carpal tunnel was performed first with longitudinal incision in the palm carried down through the skin and subcutaneous tissues.  The palmar fascia was divided exposing the transverse carpal ligament, which was incised longitudinally.  A Freer was then inserted beneath the ligament, and dissection was carried out proximally and distally.,After adequate release has been formed, the wound was irrigated and closed with nylon.  The medial approach to the elbow was then performed and the skin was opened and subcutaneous tissues were dissected.  A medial antebrachial cutaneous nerve was identified and protected throughout the case.  The ulnar nerve was noted to be subluxing over the superior aspect of the medial epicondyle and flattened and inflamed.  The ulnar nerve was freed proximally and distally.  The medial intramuscular septum was excised and the flexor carpi ulnaris fascia was divided.  The intraarticular branch and the first branch to the SCU were transected; and then the nerve was transposed, it did not appear to have any significant tension or sharp turns.  The fascial sling was made from the medial epicondyle and sewn to the subcutaneous tissues and the nerve had good translation with flexion and extension of the elbow and not too tight.  The wound was irrigated.  The tourniquet was deflated and the wound had excellent hemostasis.  The subcutaneous tissues were closed with #2-0 Vicryl and the skin was closed with staples.  Prior to the tourniquet being deflated, the subcutaneous dissection was carried out over to the olecranon bursa, where the loose fragments were excised with a rongeurs as well as abrading the ulnar cortex and excision of hypertrophic bursa.  A posterior splint was applied.  Marcaine was injected into the incisions and the splint was reinforced with tape.  He was awakened from the anesthesia and taken to recovery room in a stable condition.  Final needle, instrument, and sponge counts were correct.
---
DESCRIPTION: Right ulnar nerve transposition, right carpal tunnel release, and right excision of olecranon bursa.  Right cubital tunnel syndrom, carpal tunnel syndrome, and olecranon bursitis.

surgery, cubital tunnel syndrome, carpal tunnel syndrome, olecranon bursitis, ulnar nerve transposition, carpal tunnel release, excision of olecranon bursa, transposition, ligament, tourniquet, excision, bursa, syndrome, subcutaneous, ulnar, olecranon, carpal, nerve, tunnel,

The situation involves a surgical procedure that includes multiple operations: ulnar nerve transposition, carpal tunnel release, and excision of olecranon bursa. While these are routine procedures for addressing conditions like cubital tunnel syndrome and carpal tunnel syndrome, any surgery carries inherent risks. These include potential complications from anesthesia, infection, nerve damage, and more. However, the documentation indicates that there were no complications, minimal blood loss, and that the patient was stable post-operation. This suggests low immediate risk, but the procedures are indeed high-stakes due to the potential impact on the patient's nerve function and recovery. Thus, it is important, but not life-threatening in the context of this documentation.


Medical Specialty: Surgery
Sample Name: Tubal Ligation - Laparoscopic

PREOPERATIVE DIAGNOSIS:,  Desires permanent sterilization.,POSTOPERATIVE DIAGNOSIS: , Desires permanent sterilization.,PROCEDURE: , Laparoscopic tubal ligation, Falope ring method.,ANESTHESIA: , General.,ESTIMATED BLOOD LOSS: , 10 mL.,COMPLICATIONS: , None.,INDICATIONS FOR SURGERY:  ,A 35-year-old female, P4-0-0-4, who desires permanent sterilization.  The risks of bleeding, infection, damage to other organs, and subsequent ectopic pregnancy was explained.  Informed consent was obtained.,OPERATIVE FINDINGS: , Normal appearing uterus and adnexa bilaterally.,DESCRIPTION OF PROCEDURE: , After administration of general anesthesia, the patient was placed in the dorsal lithotomy position, and prepped and draped in the usual sterile fashion.  The speculum was placed in the vagina, the cervix was grasped with the tenaculum, and a uterine manipulator inserted.  This area was then draped off the remainder of the operative field.,A 5-mm incision was made umbilically after injecting 0.25% Marcaine, 2 mL.  A Veress needle was inserted to confirm an opening pressure of 2 mmHg.  Approximately 4 liters of CO2 gas was insufflated into the abdominal cavity.  The Veress needle was removed, and a 5-mm port placed.  Position was confirmed using a laparoscope.  A second port was placed under direct visualization, 3 fingerbreadths suprapubically, 7 mm in diameter, after 2 mL of 0.25% Marcaine was injected.  This was done under direct visualization.  The pelvic cavity was examined with the findings as noted above.  The Falope rings were then applied to each tube bilaterally.  Good segments were noted to be ligated.  The accessory port was removed.  The abdomen was deflated.  The laparoscope and sheath was removed.  The skin edges were approximated with 5-0 Monocryl suture in subcuticular fashion.  The instruments were removed from the vagina.  The patient was returned to the supine position, recalled from anesthesia, and transferred to the recovery room in satisfactory condition.  Sponge and needle counts correct at the conclusion of the case.  Estimated blood loss was minimal.
---
DESCRIPTION: Desires permanent sterilization.  Laparoscopic tubal ligation, Falope ring method.  Normal appearing uterus and adnexa bilaterally.

surgery, tenaculum, uterine manipulator, veress needle, tubal ligation, permanent sterilization, uterus, adnexa, cavity, laparoscope, laparoscopic, needle, sterilization

The situation described involves a surgical procedure, specifically laparoscopic tubal ligation, which typically involves minimal risk and is performed for permanent sterilization. This procedure is routine and elective, with minimal blood loss and no complications reported in this case. Given the standard nature of the procedure and the lack of complications, the stakes are moderate but not exceptionally high. However, surgery always carries some inherent risks, such as complications related to anesthesia or unforeseen surgical issues, which merits a moderate stakes evaluation. Additionally, for the patient, the decision for permanent sterilization is significant, although medically, it is considered low risk.


Medical Specialty: Surgery
Sample Name: TURBT

PREOPERATIVE DIAGNOSIS:  ,Clinical stage Ta Nx Mx transitional cell carcinoma of the urinary bladder.,POSTOPERATIVE DIAGNOSIS: , Clinical stage Ta Nx Mx transitional cell carcinoma of the urinary bladder.,TITLE OF OPERATION: , Cystoscopy, transurethral resection of medium bladder tumor (4.0 cm in diameter), and direct bladder biopsy.,ANESTHESIA: , General laryngeal mask.,INDICATIONS: , This patient is a 59-year-old white male, who had an initial occurrence of a transitional cell carcinoma 5 years back.  He was found to have a new tumor last fall, and cystoscopy in November showed Ta papillary-appearing lesion inside the bladder neck anteriorly.  The patient had coronary artery disease and required revascularization, which occurred at the end of December prior to the tumor resection.  He is fully recovered and cleared by Cardiology and taken to the operating room at this time for TURBT.,FINDINGS: , Cystoscopy of the anterior and posterior urethra was within normal limits.  From 12 o'clock to 4 o'clock inside the bladder neck, there was a papillary tumor with some associated blood clot.  This was completely resected.  There was an abnormal dysplastic area in the left lateral wall that was biopsied, and the remainder of the bladder mucosa appeared normal.  The ureteral orifices were in the orthotopic location.  Prostate was 15 g and benign on rectal examination, and there was no induration of the bladder.,PROCEDURE IN DETAIL: , The patient was brought to the cystoscopy suite, and after adequate general laryngeal mask anesthesia obtained, placed in the dorsal lithotomy position and his perineum and genitalia were sterilely prepped and draped in usual fashion.  He had been given oral ciprofloxacin for prophylaxis.  Rectal bimanual examination was performed with the findings described.  Cystourethroscopy was performed with a #23-French ACMI panendoscope and 70-degree lens with the findings described.  A barbotage urine was obtained for cytology.  The cystoscope was removed and a #24-French continuous flow resectoscope sheath was introduced over visual obturator and cold cup biopsy forceps introduced.  Several biopsies were taken from the tumor and sent to the tumor bank.  I then introduced the Iglesias resectoscope element and resected all the exophytic tumor and the lamina propria.  Because of the Ta appearance, I did not intentionally dissect deeper into the muscle.  Complete hemostasis was obtained.  All the chips were removed with an Ellik evacuator.  Using the cold cup biopsy forceps, biopsy was taken from the dysplastic area in the left bladder and hemostasis achieved.  The irrigant was clear.  At the conclusion of the procedure, the resectoscope was removed and a #24-French Foley catheter was placed for efflux of clear irrigant.  The patient was then returned to the supine position, awakened, extubated, and taken on a stretcher to the recovery room in satisfactory condition.
---
DESCRIPTION: Cystoscopy, transurethral resection of medium bladder tumor (4.0 cm in diameter), and direct bladder biopsy.

surgery, transitional cell carcinoma, urinary bladder, bladder tumor, cystoscopy, transurethral resection, acmi panendoscope, foley catheter, cold cup biopsy forceps, ta nx mx, cold cup biopsy, laryngeal mask, bladder neck, bladder, biopsy, tumor,

The situation involves a surgical procedure for a patient with a history of bladder cancer and coronary artery disease, making it a moderately high-stakes situation. Surgical procedures inherently come with risks such as complications from anesthesia, bleeding, or infection. The patient's previous cardiac history adds to this complexity, although he has been cleared by cardiology. However, this is a standard procedure (TURBT) and is relatively common, hence not in the highest risk category.


Medical Specialty: Surgery
Sample Name: True Cut Needle Biopsy - Breast

PREOPERATIVE DIAGNOSIS:,  Carcinoma of the left breast.,POSTOPERATIVE DIAGNOSIS:,  Carcinoma of the left breast.,PROCEDURE PERFORMED: , True cut needle biopsy of the breast.,GROSS FINDINGS:  ,This 65-year-old female on exam was noted to have dimpling and puckering of the skin associated with nipple discharge.  On exam, she has a noticeable carcinoma of the left breast with dimpling, puckering, and erosion through the skin.  At this time, a true cut needle biopsy was performed.,PROCEDURE: , The patient was taken to operating room, is laid in the supine position, sterilely prepped and draped in the usual fashion.  The area over the left breast was infiltrated with 1:1 mixture of 0.25% Marcaine and 1% Xylocaine.  Using a #18 gauge automatic true cut needle core biopsy, five biopsies were taken of the left breast in core fashion.  Hemostasis was controlled with pressure.  The patient tolerated the procedure well, pending the results of biopsy.
---
DESCRIPTION: True cut needle biopsy of the breast.  This 65-year-old female on exam was noted to have dimpling and puckering of the skin associated with nipple discharge.  On exam, she has a noticeable carcinoma of the left breast with dimpling, puckering, and erosion through the skin.

surgery, carcinoma, true cut needle biopsy, nipple, discharge, dimpling, puckering, breast,

The situation involves a medical procedure, specifically a true cut needle biopsy for a diagnosed breast carcinoma, which aids in determining the cancer's characteristics. While not as invasive as other surgical procedures, the biopsy results are crucial for diagnosing and planning further treatment, impacting the patient's health outcomes significantly.


Medical Specialty: Surgery
Sample Name: Tun-L Catheter Placement

PREOPERATIVE DIAGNOSIS:,  Low Back Syndrome - Low back pain with left greater than right lower extremity radiculopathy.,POSTOPERATIVE DIAGNOSIS:,  Same.,PROCEDURE:,1.  Nerve root decompression at L45 on the left side.,2.  Tun-L catheter placement with injection of steroid solution and Marcaine at L45 nerve roots left.,3.  Interpretation of radiograph.,ANESTHESIA: , IV sedation with Versed and Fentanyl.,ESTIMATED BLOOD LOSS:,  None.,COMPLICATIONS:,  None.,INDICATION FOR PROCEDURE: , Severe and excruciating pain in the lumbar spine and lower extremity.  MRI shows disc pathology as well as facet arthrosis.,SUMMARY OF PROCEDURE: , The patient was admitted to the operating room, consent was obtained and signed.  The patient was taken to the Operating room and was placed in the prone position.  Monitors were placed, including EKG, pulse oximeter and blood pressure monitoring.  After adequate IV sedation with Versed and Fentanyl the procedure was begun.,The lumbar sacral region was prepped and draped in sterile fashion with Betadine and four sterile towels.  After the towels were places then sterile drapes were placed on top of that.,After which time the Epimed catheter was then placed, this was done by first repositioning the C-Arm to visualize the lumbar spine and the vertebral bodies were then counted beginning at L5, verifying the sacral hiatus.  The skin over the sacral hiatus was then injected with 1% Lidocaine and an #18-gauge needle was used for skin puncture.  The #18-gauge needle was inserted off of midline.  A #16-gauge RK needle was then placed into the skin puncture and using the paramedian approach and loss-of-resistance technique the needle was placed.  Negative aspiration was carefully performed.  Omnipaque 240 dye was then injected through the #16-gauge RK needle.  The classical run off was noted.  A filling defect was noted @ L45 nerve root on the left side.  After which time 10 cc of 0.25% Marcaine/Triamcinolone (9/1 mixture) was then infused through the 16 R-K Needle.  Some additional lyses of adhesions were visualized as the local anesthetic displaced the Omnipaque 240 dye using this barbotage technique.,An Epimed Tun-L catheter was then inserted through the #16-gauage R-K needle and threaded up to the L45 interspace under continuous fluoroscopic guidance.  As the catheter was threaded up under continuous fluoroscopic visualization lyses of adhesions were visualized.  The tip of the catheter was noted to be @ L45 level on the left side.  After this the #16-gauge RK needle was then removed under fluoroscopic guidance verifying that the tip of the catheter did not migrate from the L45 nerve root region on the left side.  After this was successfully done, the catheter was then secured in place; this was done with Neosporin ointment, a Split 2x2, Op site and Hypofix tape.  The catheter was then checked with negative aspiration and the Omnipaque 240 dye was then injected.  The classical run off was noted in the lumbar region.  Some lyses of adhesions were also visualized at this time with barbotage technique.  Good dye spread was noted to extend one level above and one level below the L45 nerve root and bilateral spread was noted.  Nerve root decompression was visualized as dye spread into the nerve root whereas prior this was a filling defect.  After which time negative aspiration was again performed through the Epimed® Tun-L catheter and then 10 cc of solution was then infused through the catheter, this was done over a 10-minute period with initial 3 cc test dose.  Approximately 3 minutes elapsed and then the remaining 7 cc were infused (Solution consisting of 8 cc of 0.25% Marcaine, 2 cc of Triamcinolone and 1 cc of Wydase.)  The catheter was then capped with a bacterial filter.  The patient was noted to have tolerated the procedure well without any complications.,Interpretation of radiograph revealed nerve root adhesions present with lysis of these adhesions as the procedure was performed.  A filling defect was seen at the L45 nerve root and this filling defect being significant of fibrosis and adhesions in this region was noted to be lysed with the insertion of the catheter as well as the barbotage procedure.  This verified positive nerve root decompression.  The tip of the Epimed Tun L catheter was noted to be at L45 level on the left side.  Positive myelogram without dural puncture was noted during this procedure; no sub-dural spread of Omnipaque 240 dye was noted.  This patient did not report any problems and reported pain reduction.
---
DESCRIPTION: Nerve root decompression at L45 on the left side.  Tun-L catheter placement with injection of steroid solution and Marcaine at L45 nerve roots left.  Interpretation of radiograph.

surgery, low back syndrome, low back pain, nerve root decompression, steroid solution, c-arm, epimed, tun l catheter, nerve root, negative aspiration, omnipaque dye, filling defect, nerve, root, catheter, adhesions, injection, needle,

The procedure described is a surgical intervention for severe back pain involving intricate steps like nerve root decompression and catheter placement, which carry inherent risks due to their involvement with critical spinal structures. Although the surgery was performed without complications and is considered routine, the stakes are moderate because of the potential implications for the patient's mobility and well-being if something were to go wrong.


Medical Specialty: Surgery
Sample Name: Tubal Fulguration - Laparoscopic

A 1 cm infraumbilical skin incision was made.  Through this a Veress needle was inserted into the abdominal cavity.  The abdomen was filled with approximately 2 liters of CO2 gas.  The Veress needle was withdrawn.  A trocar sleeve was placed through the incision into the abdominal cavity.  The trocar was withdrawn and replaced with the laparoscope.  A 1 cm suprapubic skin incision was made.  Through this a second trocar sleeve was placed into the abdominal cavity using direct observation with the laparoscope.  The trocar was withdrawn and replaced with a probe.,The patient was placed in Trendelenburg position, and the bowel was pushed out of the pelvis.  Upon visualization of the pelvis organs, the uterus, fallopian tubes and ovaries were all normal.  The probe was withdrawn and replaced with the bipolar cautery instrument.  The right fallopian tube was grasped approximately 1 cm distal to the cornual region of the uterus.  Electrical current was applied to the tube at this point and fulgurated.  The tube was then regrasped just distal to this and refulgurated.  It was then regrasped just distal to the lateral point and refulgurated again.  The same procedure was then carried out on the opposite tube.  The bipolar cautery instrument was withdrawn and replaced with the probe.  The fallopian tubes were again traced to their fimbriated ends to confirm the burn points on the tubes.  The upper abdomen was visualized, and the liver surface was normal.  The gas was allowed to escape from the abdomen, and the instruments were removed.  The skin incisions were repaired.  The instruments were removed from the vagina.,There were no complications to the procedure.  Blood loss was minimal.  The patient went to the postanesthesia recovery room in stable condition.
---
DESCRIPTION: Laparoscopic tubal fulguration.

Laparoscopic tubal fulguration.

surgery, tubal fulguration, cohen cannula, laparoscopic, trendelenburg position, veress needle, abdominal cavity, bipolar cautery, dorsal lithotomy, fallopian tubes, fimbriated ends, fulgurated, laparoscope, uterus, distal, trocar, tubesNOTE,: Thesetranscribed medical transcription sample reports and examples are provided by various users andare for reference purpose only. MTHelpLine does not certify accuracy and quality of sample reports.These transcribed medical transcription sample reports may include some uncommon or unusual formats;this would be due to the preference of the dictating physician. All names and dates have beenchanged (or removed) to keep confidentiality. Any resemblance of any type of name or date orplace or anything else to real world is purely incidental.

The procedure described is a laparoscopic tubal fulguration, which is typically performed as an elective sterilization procedure. While not considered as high-stakes as emergency surgeries or life-saving interventions, it is still a surgical procedure involving anesthesia and manipulation of internal organs, which carries inherent risks such as infection, injury to surrounding organs, or complications from anesthesia. The description notes that the procedure was performed without complications and the patient went to recovery in stable condition, which indicates the situation was managed well. However, it remains moderately high-stakes due to the surgical nature and implications of the procedure.


Medical Specialty: Surgery
Sample Name: Tubal Ligation

DIAGNOSIS: , Multiparous female, desires permanent sterilization.,NAME OF OPERATION: , Laparoscopic bilateral tubal ligation with Falope rings.,ANESTHESIA: , General, ET tube.,COMPLICATIONS:,  None.,FINDINGS:  ,Normal female anatomy except for mild clitoromegaly and a posterior uterine fibroid.,PROCEDURE: , The patient was taken to the operating room and placed on the table in the supine position.  After adequate general anesthesia was obtained, she was placed in the lithotomy position and examined.  She was found to have an anteverted uterus and no adnexal mass.  She was prepped and draped in the usual fashion.  The Foley catheter was placed.  A Hulka cannula was inserted into the cervix and attached to the anterior lip of the cervix.,An infraumbilical incision was made with the knife.  A Veress needle was inserted into the abdomen.  Intraperitoneal location was verified with approximately 10 cc of sterile solution.  A pneumoperitoneum was created.  The Veress needle was then removed, and a trocar was inserted directly without difficulty.  Intraperitoneal location was verified visually with the laparoscope.  There was no evidence of any intra-abdominal trauma.,Each fallopian tube was elevated with a Falope ring applicator, and a Falope ring was placed on each tube with a 1-cm to 1.5-cm portion of the tube above the Falope ring.,The pneumoperitoneum was evacuated, and the trocar was removed under direct visualization.  An attempt was made to close the fascia with a figure-of-eight suture.  However, this was felt to be more subcutaneous.  The skin was closed in a subcuticular fashion, and the patient was taken to the recovery room awake with vital signs stable.
---
DESCRIPTION: Laparoscopic bilateral tubal ligation with Falope rings.

surgery, sterilization, laparoscopic bilateral tubal ligation with falope rings, falope ring applicator, laparoscopic bilateral tubal ligation, bilateral tubal ligation, veress needle, tubal ligation, falope rings, anesthesia, tubal, ligation, falope

The described procedure is a laparoscopic bilateral tubal ligation, which is a relatively routine surgical procedure for permanent sterilization. It's generally considered elective and low-risk, particularly with no complications reported. However, as any surgery, it carries standard risks associated with anesthesia and surgical interventions. Though the stakes are not high in comparison to emergency or life-threatening procedures, proper execution is essential for patient safety and ensuring the desired outcome (permanent sterility).


Medical Specialty: Surgery
Sample Name: Triple Lumen Catheter Insertion

PREOPERATIVE DIAGNOSES:,1.  Hyperpyrexia/leukocytosis.,2.  Ventilator-dependent respiratory failure.,3.  Acute pancreatitis.,POSTOPERATIVE DIAGNOSES:,1.  Hyperpyrexia/leukocytosis.,2.  Ventilator-dependent respiratory failure.,3.  Acute pancreatitis.,PROCEDURE PERFORMED:,1.  Insertion of a right brachial artery arterial catheter.,2.  Insertion of a right subclavian vein triple lumen catheter.,ANESTHESIA: , Local, 1% lidocaine.,BLOOD LOSS:,  Less than 5 cc.,COMPLICATIONS: , None.,INDICATIONS: , The patient is a 46-year-old Caucasian female admitted with severe pancreatitis.  She was severely dehydrated and necessitated some fluid boluses.  The patient became hypotensive, required many fluid boluses, became very anasarcic and had difficulty with breathing and became hypoxic.  She required intubation and has been ventilator-dependent in the Intensive Care since that time.  The patient developed very high temperatures as well as leukocytosis.  Her lines required being changed.,PROCEDURE:,1.  RIGHT BRACHIAL ARTERIAL LINE:  ,The patient's right arm was prepped and draped in the usual sterile fashion.  There was a good brachial pulse palpated.  The artery was cannulated with the provided needle and the kit.  There was good arterial blood return noted immediately.  On the first stick, the Seldinger wire was inserted through the needle to cannulate the right brachial artery without difficulty.  The needle was removed and a catheter was inserted over the Seldinger wire to cannulate the brachial artery.  The femoral catheter was used in this case secondary to the patient's severe edema and anasarca.  We did not feel that the shorter catheter would provide enough length.  The catheter was connected to the system and flushed without difficulty.  A good waveform was noted.  The catheter was sutured into place with #3-0 silk suture and OpSite dressing was placed over this.,2.  RIGHT SUBCLAVIAN TRIPLE LUMEN CATHETER:  ,The patient was prepped and draped in the usual sterile fashion.  1% Xylocaine was used to anesthetize an area just inferior and lateral to the angle of the clavicle.  Using the anesthetic needle, we checked down to the soft tissues anesthetizing, as we proceeded to the angle of the clavicle, this was also anesthetized.  Next, a #18 gauge thin walled needle was used following the same track to the angle of clavicle.  We roughed the needle down off the clavicle and directed it towards the sternal notch.  There was good venous return noted immediately.  The syringe was removed and a Seldinger guidewire was inserted through the needle to cannulate the vein.  The needle was then removed.  A small skin nick was made with a #11 blade scalpel and the provided dilator was used to dilate the skin, soft tissue and vein.  Next, the triple lumen catheter was inserted over the guidewire without difficulty.  The guidewire was removed.  All the ports aspirated and flushed without difficulty.  The catheter was sutured into place with #3-0 silk suture and a sterile OpSite dressing was also applied.  The patient tolerated the above procedures well.  A chest x-ray has been ordered, however, it has not been completed at this time, this will be checked and documented in the progress notes.
---
DESCRIPTION: Insertion of a right brachial artery arterial catheter and a right subclavian vein triple lumen catheter.  Hyperpyrexia/leukocytosis, ventilator-dependent respiratory failure, and acute pancreatitis.

surgery, hyperpyrexia, leukocytosis, ventilator-dependen, respiratory failure, pancreatitis, brachial artery, arterial catheter, subclavian vein, triple lumen catheter, catheter, brachial, needle,

The situation described involves a complex medical procedure on a critically ill patient with severe pancreatitis, ventilator-dependent respiratory failure, and hyperpyrexia/leukocytosis. The insertion of catheters in such a context suggests it is part of intensive care management, where precision and timely intervention are critical for the patient's outcome. While the procedure has reportedly gone smoothly with no immediate complications, any invasive procedure on a patient in a fragile health state inherently carries a significant degree of risk and importance, affecting the patient's recovery and overall treatment strategy.


Medical Specialty: Surgery
Sample Name: Trigger Thumb Release

PROCEDURE:  ,Trigger thumb release.,PROCEDURE IN DETAIL: , After administering appropriate antibiotics and MAC anesthesia, the upper extremity was prepped and draped in the usual sterile fashion.  The arm was exsanguinated with Esmarch, and the tourniquet inflated to 250 mmHg.,A transverse incision was made over the MPJ crease of the thumb.  Dissection was carried down to the flexor sheath with care taken to identify and protect the neurovascular bundles.  The flexor sheath was opened under direct vision with a scalpel, and then a scissor was used to release the A1 pulley under direct vision on the radial side, from its proximal extent to its distal extent at the junction of the proximal and middle thirds of the proximal phalanx.  Meticulous hemostasis was maintained with bipolar electrocautery.,The flexor pollicis longus tendon was identified and atraumatically pulled to ensure that no triggering remained.  The patient then actively moved the thumb and no triggering was noted.,After irrigating out the wound with copious amounts of sterile saline, the skin was closed with 5-0 nylon simple interrupted sutures.,The wound was dressed and the patient was sent to the recovery room in good condition, having tolerated the procedure well.
---
DESCRIPTION: Trigger thumb release.  A transverse incision was made over the MPJ crease of the thumb.  Dissection was carried down to the flexor sheath with care taken to identify and protect the neurovascular bundles.

surgery, neurovascular, a1 pulley, trigger thumb release, mpj crease, trigger thumb, flexor sheath, triggering, sheath, proximal, incision

The procedure described is a surgical intervention for trigger thumb, which involves releasing a tendon to relieve symptoms. While surgery always carries some level of risk, trigger thumb release is generally considered a routine and safe procedure with low complexity. The detailed description indicates it was carried out with standard precautions and resulted in no immediate complications, suggesting low stakes in terms of the patient's immediate health outcome. However, as with any surgical intervention, there are inherent risks such as infection, bleeding, or injury to surrounding structures, which prevent it from being extremely low-stakes.


You are an LLM as part of a medical assistant system, interacting with medical practitioners to improve efficiency.

Medical Specialty: Surgery
Sample Name: Transesophageal Echocardiography Probe

INDICATIONS FOR PROCEDURE:,  Impending open heart surgery for closure of ventricular septal defect in a 4-month-old girl.,Procedures were done under general anesthesia.  The patient was already in the operating room under general anesthesia.  Antibiotic prophylaxis with cefazolin and gentamicin was already given prior to beginning the procedures.,PROCEDURE #1:,  Insertion of transesophageal echocardiography probe.,DESCRIPTION OF PROCEDURE #1: , The probe was well lubricated and with digital manipulation, was passed into the esophagus without resistance.  The probe was placed so that the larger diameter was in the anterior-posterior position during insertion.  The probe was used by the pediatric cardiologist for preoperative and postoperative diagnostic echocardiography.  At the end, it was removed without trauma and there was no blood tingeing.  It is to be noted that approximately 30 minutes after removing the cannula, I inserted a 14-French suction tube to empty the stomach and there were a few mL of blood secretions that were suctioned.  There was no overt bleeding.,PROCEDURE #2: , Attempted and unsuccessful insertion of arterial venous lines.,DESCRIPTION OF PROCEDURE #2:,  Both groins were prepped and draped.  The patient was placed at 10 degrees head-up position.  A Cook 4-French double-lumen 8-cm catheter kit was opened.  Using the 21-gauge needle that comes with the kit, several attempts were made to insert central venous and then an arterial line in the left groin.  There were several successful punctures of these vessels, but I was unable to advance Seldinger wire.  After removal of the needles, the area was compressed digitally for approximately 5 minutes.  There was a small hematoma that was not growing.  Initially, the left leg was mildly mottled with prolonged capillary refill of approximately 3 seconds.  Using 1% lidocaine, I infiltrated the vessels of the groin both medial and lateral to the vascular sheath.  Further observation, the capillary refill and circulation of the left leg became more than adequate.  The O2 saturation monitor that was on the left toe functioned well throughout the procedures, from the beginning to the end.  At the end of the procedure, the circulation of the leg was intact.,
---
DESCRIPTION: Insertion of transesophageal echocardiography probe and unsuccessful insertion of arterial venous lines.

surgery, impending open heart surgery, ventricular septal defect, antibiotic prophylaxis, cefazolin, transesophageal echocardiography probe, arterial venous lines, groin, transesophageal echocardiography, echocardiography probe, insertion, transesophageal, arterial, venous, groins, echocardiography, probe

The situation involves a 4-month-old undergoing a complex open-heart surgery, where transesophageal echocardiography is used to guide the surgical procedure and monitor post-operative outcomes. The patient's youth and the complexity of open-heart surgery inherently make the situation high-stakes. Furthermore, the failure to insert arterial venous lines, despite being monitored and managed for adverse effects like hematoma and compromised circulation, adds to the critical nature. These are vital for proper hemodynamic monitoring and are essential in managing any intraoperative complications. The scenario involves delicate and crucial procedures central to the patient's survival and recovery.


Medical Specialty: Surgery
Sample Name: Total Thyroidectomy

PREOPERATIVE DIAGNOSIS:  ,Thyroid goiter with substernal extension on the left.,POSTOPERATIVE DIAGNOSIS:,  Thyroid goiter with substernal extension on the left.,PROCEDURE PERFORMED:,  Total thyroidectomy with removal of substernal extension on the left.,THIRD ANESTHESIA: , General endotracheal.,ESTIMATED BLOOD LOSS: , Approximately 200 cc.,COMPLICATIONS: , None.,INDICATIONS FOR PROCEDURE:,  The patient is a 54-year-old Caucasian male with a history of an enlarged thyroid gland who presented to the office initially with complaints of dysphagia and some difficulty in breathing while lying supine.  The patient subsequently then had a CT scan which demonstrated a very large thyroid gland, especially on the left side with substernal extension down to the level of the aortic arch.  The patient was then immediately set up for surgery.  After risks, complications, consequences, and questions were addressed with the patient, a written consent was obtained.,PROCEDURE:,  The patient was brought to the operative suite by Anesthesia and placed on the operative table in the supine position.  The patient was then placed under general endotracheal intubation anesthesia and the patient then had a shoulder roll placed.  After this, the patient then had the area marked initially.  The preoperative setting was then localized with 1% lidocaine and epinephrine 1:100,000 approximately 10 cc total.  After this, the patient was then prepped and draped in the usual sterile fashion.  A #15 Bard-Parker was then utilized to make a skin incision horizontally, approximately 5 cm on either side from midline.  After this, a blunt dissection was then utilized to dissect the subcutaneous fat from the platysmal muscle.  There appeared to be a natural dehiscence of the platysma in the midline.  A sub-platysmal dissection was then performed in the superior, inferior, and lateral directions with the help of a bear claw, Metzenbaum scissors and DeBakey forceps.  Any bleeding was controlled with monopolar cauterization.  After this, the two anterior large jugular veins were noted and resected laterally.  The patient's trachea appeared to be slightly deviated to the right with identification finally of the midline raphe, off midline to the right.  This was grasped on either side with a DeBakey forceps and dissected with monopolar cauterization and dissected with a Metzenbaum scissors.  After this was dissected, the sternohyoid muscles were resected laterally and separated from the sternothyroid muscles.  The sternothyroid muscles were then bluntly freed and dissected from the right thyroid gland.  After this, attention was then drawn to the left gland, where the sternothyroid muscle was dissected bluntly on this side utilizing finger dissection and Kitners.  The left thyroid gland was freed initially superiorly and worked inferiorly and laterally until the gland was pulled from the substernal region by blunt dissection and reflected and pulled anteriorly.  After this, the superior and inferior parathyroid glands were noted.  The dissection was carried very close to the thyroid gland to try to select these parathyroids posteriorly.  After this, the superior pole was then identified and the superior laryngeal artery and vein were cross clamped and tied with __________ undyed Vicryl tie.  The superior pole was finally freed and a small little feeding branched vessels from this area were cauterized with the bipolar cautery and cut with Metzenbaum scissors.  After this, the thyroid gland was further freed down to the level of the Berry's ligament inferiorly and the dissection was carried once again more superiorly.  The fine stats were then utilized to dissect along the superior aspect of the recurrent laryngeal nerve on the left side with freeing of the connective Berry's ligament tissue from the gland with the bipolar cauterization and the fine stat.  Finally, attention was then drawn back to the patient's right side where the gland was rotated more anteriorly with fine dissection utilizing a fine stat to reflect the superior and inferior parathyroid glands laterally and posteriorly.  The recurrent laryngeal nerve on this side was identified and further dissection was carried superiorly and anteriorly through this nerve to finally free the right side of the gland to Berry's ligament.  The middle thyroid vein and inferior thyroid arteries were cross clamped and tied with #2-0 undyed Vicryl ties and also bipolared with the bipolar cauterization bilaterally.  The Berry's ligament was then finally freed and the gland was then passed to scrub tech and passed off the field to Pathology.  The neck was then thoroughly irrigated with normal saline solution and further bleeding was controlled with bipolar cauterization.  After this, Surgicel was then placed in the bilateral neck regions and a #10 Jackson-Pratt drain was then placed within the left neck region with some extension over to the right neck region.  This was brought out through the inferior skin incision and secured to the skin with a #2-0 nylon suture.  The strap muscles were then reapproximated with a running #3-0 Vicryl suture followed by reapproximation of the platysma and subcutaneous tissue with a #4-0 undyed Vicryl.  The skin was then reapproximated with a #5-0 Prolene subcuticular along with a #6-0 fast over the top.  After this, Mastisol Steri-Strips and Bacitracin along with a sterile dressing and a __________ dressing were then placed.  The patient intraoperatively did have approximately 50 cc of bloody drainage from this area within the JP drain.  The patient was then turned back to Anesthesia, extubated in the operating room and transferred to Recovery in stable condition.  The patient tolerated the procedure well and remained stable throughout.
---
DESCRIPTION: Total thyroidectomy with removal of substernal extension on the left.  Thyroid goiter with substernal extension on the left.

surgery, thyroid goiter, goiter, thyroid, total thyroidectomy, berry's ligament, dissection, gland, thyroidectomy, anesthesia, berry's, ligament, cauterization, extension, substernal,

This scenario describes a total thyroidectomy, which is a major surgical procedure involving the complete removal of the thyroid gland. This surgery was complicated by a substernal extension, which indicates that part of the thyroid extended into the chest cavity, making the surgery more complex. The procedure required careful management of important structures like the parathyroid glands and recurrent laryngeal nerve, and general anesthesia was used. While there were no reported complications, surgeries of this nature carry significant risks, including potential for airway compromise, bleeding, and damage to surrounding structures. These factors combine to make this a high-stakes medical situation.


Medical Specialty: Surgery
Sample Name: Total Thyroid Lumpectomy

PREOPERATIVE DIAGNOSIS:,  Left thyroid mass.,POSTOPERATIVE DIAGNOSIS:,  Left thyroid mass.,PROCEDURE PERFORMED:,  Left total thyroid lumpectomy.,ANESTHESIA,:  General endotracheal.,ESTIMATED BLOOD LOSS: , Less than 50 cc.,COMPLICATIONS:,  None.,INDICATIONS FOR PROCEDURE:,  The patient is a 76-year-old Caucasian female with a history of a left thyroid mass nodule that was confirmed with CT scan along with thyroid uptake scan, which demonstrated a hot nodule on the left anterior pole.  The patient was then discussed the risks, complications, and consequences of a surgical procedure and a written consent was obtained.,PROCEDURE:  ,The patient is brought to the operative suite by Anesthesia.  The patient was placed on the operative table in supine position.  After this, the patient was placed under general endotracheal intubation anesthesia and the patient was then placed upon a shoulder roll.  After this, the skin incision was marked approximately two fingerbreadths above the sternal notch.  It was then localized with 1% lidocaine with epinephrine 1:1000 approximately 7 cc total.,After this, the patient was then prepped and draped in the usual sterile fashion and a #10 blade was then utilized to make a skin incision.  The subcutaneous tissue was then bluntly dissected utilizing a Ray-Tec sponge and a bear claw was then utilized to retract the upper incisional skin with counter retraction performed to allow a subplatysmal plane of skin flaps to be performed in superior and inferolateral directions.  After this, the midline was then identified and grasped on either side with a DeBakey forceps.  The raphe was noted and Bovie cauterization was utilized to cut down into this region.  The fine stats were utilized to further open this area with exposure and bisection of the sternothyroid muscle.  It was separated on the left side from the patient's sternothyroid muscle.  After this, the sternothyroid muscle was identified, grasped with the DeBakey forceps and infiltrated initially through its fascial plane with the Metzenbaum scissors.  Blunt dissection was then utilized to free the sternothyroid muscle from the thyroid gland in superior and inferior directions and laterally with the help of Kitners.  After this, the plane was rotated more anteriorly with the superior and inferior parathyroid glands identified.  The fat cap was noted to be attached on the superior parathyroid to the posterior aspect of the thyroid itself.  It was freed from the thyroid gland and reflected laterally and posteriorly.  The inferior parathyroid gland actually appeared to be attached also to the inferior aspect of the thyroid itself and was reflected laterally.  After this, the patient's thyroid gland was palpated noting a thyroid nodule in the posterior inferior aspect along with the calcification laterally.  The nodule appeared to be sort of rubbery in consistency and approximately 1 cm diameter.  As the gland was rotated more anteriorly, the recurrent laryngeal nerve on the left side was identified and further dissection along Berry's ligament on the medial aspect was performed.  The middle thyroid vein and inferior thyroid artery were both cauterized with a bipolar cautery and bisected.  After this, the gland was easily rotated anteriorly with further dissection carried up to the superior pole.  The superior pole was exposed with the help of a Richardson and Army-Navy retractors with cross-clamping and tying of the superior laryngeal artery and vein.  Further, the small bleeding vessels were identified and bipolared, and cut with the Metzenbaum scissors.  The superior pole was finally freed and the gland was rotated more anteriorly onto the anterior aspect of the trachea.  Berry's ligament was finally freed and the gland was cross-clamped on the opposing thyroid isthmus with a mosquito.  After this, the gland was cut with a Metzenbaum scissors and tied with a #3-0 undyed Vicryl tie.  The defect on the neck now was thoroughly irrigated with normal saline solution and further bleeding was controlled with bipolar cauterization.  Surgicel was then cut in small strips and three replaced in the lateral part of the neck.,The opposing side of the thyroid gland on the right was palpated with no noticeable nodules or masses.  The strap muscles were then reapproximated with #3-0 Vicryl on a SH, followed by reapproximation of the subcutaneous tissue with #4-0 Vicryl, followed by reapproximation of the skin by running subcuticular #5-0 Prolene and a #6-0 fast absorbing gut.  Mastisol, Steri-Strips, and bacitracin were placed followed by a sterile 4 x 4 dressing.  The patient was then turned back to Anesthesia, extubated in the operating room, and transferred to Recovery in stable condition.  The patient tolerated the procedure well and will be admitted to hospital for 23-hour observation and will be followed up in one week afterwards.
---
DESCRIPTION: Left thyroid mass.  Left total thyroid lumpectomy.  The patient with a history of a left thyroid mass nodule that was confirmed with CT scan along with thyroid uptake scan, which demonstrated a hot nodule on the left anterior pole.

surgery, thyroid lumpectomy, thyroid uptake scan, thyroid mass nodule, total thyroid lumpectomy, parathyroid glands, berry's ligament, metzenbaum scissors, thyroid gland, thyroid mass, gland, thyroid, total,

The situation involves a surgical procedure, specifically a total thyroid lumpectomy. Surgery inherently carries significant risks, which can include complications related to anesthesia, bleeding, infection, damage to nearby structures (such as the recurrent laryngeal nerve), and other perioperative issues. While this particular procedure was described as having no complications and minimal blood loss, the stakes remain relatively high due to the nature of surgery and the potential impact on the patient's health and recovery. Additionally, the patient is an elderly woman, which can increase the risk associated with surgeries.


Medical Specialty: Surgery
Sample Name: Total Knee Replacement - 1

PROCEDURES: , Total knee replacement.,PROCEDURE DESCRIPTION:,  The patient was bought to the operating room and placed in the supine position.  After induction of anesthesia, a tourniquet was placed on the upper thigh.  Sterile prepping and draping proceeded.  The tourniquet was inflated to 300 mmHg.  A midline incision was made, centered over the patella.  Dissection was sharply carried down through the subcutaneous tissues.  A median parapatellar arthrotomy was performed.  The lateral patellar retinacular ligaments were released and the patella was retracted laterally.  Proximal medial tibia was denuded, with mild release of medial soft tissues.  The ACL and PCL were released.  The medial and lateral menisci and suprapatellar fat pad were removed.  These releases allowed for anterior subluxation of tibia.  An extramedullary tibial cutting jig was pinned to the proximal tibia in the appropriate alignment and flush cut was made along tibial plateau, perpendicular to the axis of the tibia.  Its alignment was checked with the rod and found to be adequate.  The tibia was then allowed to relocate under the femur.,An intramedullary hole was drilled into the femur and a femoral rod attached to the anterior cutting block was inserted, and the block was pinned in appropriate position, judging correct rotation using a variety of techniques.  An anterior rough cut was made.  The distal cutting jig was placed atop this cut surface and pinned to the distal femur, and the rod was removed.  The distal cut was performed.,A spacer block was placed, and adequate balance in extension was adjusted and confirmed, as was knee alignment.  Femoral sizing was performed with the sizer, and the appropriate size femoral 4-in-1 chamfer-cutting block was pinned in place and the cuts were made.  The notch-cutting block was pinned to the cut surface, slightly laterally, and the notch cut was then made.  The trial femoral component was impacted onto the distal femur and found to have an excellent fit.  A trial tibial plate and polyethylene were inserted, and stability was judged and found to be adequate in all planes.  Appropriate rotation of the tibial component was identified and marked.  The trials were removed and the tibia was brought forward again.  The tibial plate size was checked and the plate was pinned to plateau.  A keel guide was placed and the keel was then made.  The femoral intramedullary hole was plugged with bone from the tibia.  The trial tibial component and poly placed; and, after placement of the femoral component, range of motion and stability were checked and found to be adequate in various ranges of flexion and extension.,The patella was held in a slightly everted position with knee in extension.  Patellar width was checked with calipers.  A free-hand cut of the patellar articular surface was performed and checked to ensure symmetry with the calipers.  Sizing was then performed and 3 lug holes were drilled with the jig in place, taking care to medialize and superiorize the component as much as possible, given bony anatomy.  Any excess lateral patellar bone was recessed.  The trial patellar component was placed and found to have adequate tracking.  The trials were removed; and as the cement was mixed, all cut surfaces were thoroughly washed and dried.  The cement was applied to the components and the cut surfaces with digital pressurization, and then the components were impacted.  The excess cement was removed from the gutters and anterior and posterior parts of the knee.  The knee was brought into full extension with the trial polyethylene and further axially pressurized as cement hardened.  Once the cement had hardened, the tourniquet was deflated.  The knee was dislocated again, and any excess cement was removed with an osteotome.  Thorough irrigation and hemostasis were performed.  The real polyethylene component was placed and pinned.  Further vigorous power irrigation was performed, and adequate hemostasis was obtained and confirmed.  The arthrotomy was closed using 0 Ethibond and Vicryl sutures.  The subcutaneous tissues were closed after further irrigation with 2-0 Vicryl and Monocryl sutures.  The skin was sealed with staples.  Xeroform and a sterile dressing were applied followed by a cold-pack and Ace wrap.  The patient was transferred to the recovery room in stable condition, having tolerated the procedure well.
---
DESCRIPTION: Total knee replacement.  A midline incision was made, centered over the patella.  Dissection was sharply carried down through the subcutaneous tissues.  A median parapatellar arthrotomy was performed.

surgery, proximal medial tibia, total knee replacement, parapatellar arthrotomy, subcutaneous tissues, tibial plateau, incision, cutting, patella, femur, femoral, component, knee,

The situation involves a total knee replacement surgery, which is a significant medical procedure. Surgical operations inherently carry high stakes due to the risks of complications, the necessity for precision, and the impact on the patient's quality of life. While the described procedure seems to have been completed successfully without complications, the inherent risks and importance of the procedure still classify it as high-stakes. The potential for postoperative issues further underscores the seriousness.


Medical Specialty: Surgery
Sample Name: Tracheostomy & SCOOP Procedure

PREOPERATIVE DIAGNOSES:,1.  Oxygen dependency.,2.  Chronic obstructive pulmonary disease.,POSTOPERATIVE DIAGNOSES:,1.  Oxygen dependency.,2.  Chronic obstructive pulmonary disease.,PROCEDURES PERFORMED:,1.  Tracheostomy with skin flaps.,2.  SCOOP procedure FastTract.,ANESTHESIA: , Total IV anesthesia.,ESTIMATED BLOOD LOSS: , Minimal.,COMPLICATIONS:  ,None.,INDICATIONS FOR PROCEDURE: , The patient is a 55-year-old Caucasian male with a history of chronic obstructive pulmonary disease and O2 dependency of approximately 5 liters nasal cannula at home.  The patient with extensive smoking history who presents after risks, complications, and consequences of the SCOOP FastTract procedure were explained.,PROCEDURE:,  The patient was brought to operating suite by Anesthesia and placed on the operating table in the supine position.  After this, the patient was then placed under total IV anesthesia and the operating bed was then placed in reverse Trendelenburg.  The patient's sternal notch along with cricoid and thyroid cartilages were noted and palpated and a sternal marker was utilized to mark the cricoid cartilage in the sternal notch.  The midline was also marked and 1% lidocaine with epinephrine 1:100,000 at approximately 4 cc total was then utilized to localize the neck.  After this, the patient was then prepped and draped with Hibiclens.  A skin incision was then made in the midline with a #15 Bard-Parker in a vertical fashion.  After this, the skin was retracted laterally and a small anterior jugular branch was clamped and cross clamped and tied with #2-0 undyed Vicryl ties.  Further bleeding was controlled with monopolar cauterization and attention was then drawn down on to the strap muscles.  The patient's sternohyoid muscle was identified and grasped on either side and the midline raphe was identified.  Cauterization was then utilized to take down the midline raphe and further dissection was utilized with the skin hook and stat clamps.  The anterior aspect of the thyroid isthmus was identified and palpation on the cricoid cartilage was performed.  The cricoid cauterization over the cricoid cartilage was obtained with the monopolar cauterization and blunt dissection then was carried along the posterior aspect of the thyroid isthmus.  Stats were then placed on either side of the thyroid isthmus and the mid portion was bisected with the monopolar cauterization.  After this, the patient's anterior trachea was then identified and cleaned with pusher.  After this, the cricoid cartilage along the first and second tracheal rings was identified.  The cricoid hook was placed and the trachea was brought more anteriorly and superiorly.  After this, the patient's head incision was placed below the second tracheal ring with a #15 Bard-Parker.  After this, the patient had a tracheal punch with the SCOOP FastTract kit to create a small 4 mm punch within the tracheal cartilage.  After this, the patient then had a tracheal stent placed within the tracheal punched lumen and the patient was then had the tracheal stent secured to the neck with a Vicryl strap.  After this, the cricoid hook was removed and the patient then had FiO2 on the monitor noted with pulse oximetry of 100%.  The patient was then turned back to the anesthesia and transferred to the recovery room in stable condition.  The patient tolerated the procedure well and will stay in the hospital for approximately 23 hours.  The patient will have the stent guidewire removed with a scoop catheter 11 cm placed.
---
DESCRIPTION: Tracheostomy with skin flaps and SCOOP procedure FastTract.  Oxygen dependency of approximately 5 liters nasal cannula at home and chronic obstructive pulmonary disease.

surgery, oxygen dependency, chronic obstructive pulmonary disease, tracheostomy, scoop procedure, nasal cannula, scoop procedure fasttract, thyroid isthmus, cricoid cartilage, isthmus, oxygen, dependency, scoop, cartilages

The situation involves a specialized surgical procedure, tracheostomy with skin flaps, and a SCOOP procedure on a patient with significant health issues such as chronic obstructive pulmonary disease and oxygen dependency. Such procedures require careful planning, precision, and are performed in an operating room under anesthesia, making them high-stakes due to the potential risks and complexities. However, the surgery report indicates the procedure went smoothly without complications, and the patient remained stable. While the specific procedure seems routine given the skill level and control demonstrated, any surgical intervention on a patient with existing vulnerabilities can have high stakes because of inherent risks and the need for recovery and monitoring post-operation.


Medical Specialty: Surgery
Sample Name: Total Knee Arthroplasty - Right

PREOPERATIVE DIAGNOSIS (ES):, Osteoarthritis, right knee.,POSTOPERATIVE DIAGNOSIS (ES):, Osteoarthritis, right knee.,PROCEDURE:, Right total knee arthroplasty.,DESCRIPTION OF THE OPERATION:, The patient was brought to the Operating Room and after the successful placement of an epidural, as well as general anesthesia, administration 1 gm of Ancef preoperatively, the patient's right thigh, knee and leg were scrubbed, prepped and draped in the usual sterile fashion. The leg was exsanguinated by gravity and pneumatic tourniquet was inflated to 300 mmHg.,A straight anterior incision was carried down through the skin and subcutaneous tissue. Unilateral flaps were developed and a median retinacular parapatellar incision was made. The extensor mechanism was partially divided and the patella was everted. Some of the femoral bone spurs were resected using an osteotome and a rongeur. Ascending drill hole was made in the distal femur and the distal femoral cut, anterior and posterior and chamfer cuts were accomplished for a 67.5 femoral component.,At this point the ACL was resected. Some of the fat pad and synovium were resected, as well as both medial and lateral menisci. A posterior cruciate retractor was utilized, the tibia brought forward and a centering drill hole made in the tibia. The intramedullary guide was used for cutting the tibia. It was set at 8 mm. An additional 2 mm was resected because of a moderate defect medially.,A trial reduction was done with a 71 tibial baseplate. This was pinned and drilled and then trial reduction done with a 10-mm insert.,This gave good stability and a full range of motion.,The patella was measured with the calibers and 9 mm of bone was resected with an oscillating saw. A 34-mm component was drilled for.,A further trial reduction was done and two liters of pulse lavage were used to clean the bony surfaces. A packet of cement was hand mixed, pressurized with a spatula into the proximal tibia. Multiple drill holes were made on the medial side of the tibia where the bone was somewhat sclerotic. The tibia baseplate was secured and the patella was inserted, held with a clamp. The extraneous cement was removed. At this point the tibial baseplate was locked into place and the femoral component also seated solidly.,The knee was extended, held in this position for another 5-6 minutes until the cement was cured. Further extraneous cement was removed. The pneumatic tourniquet was released, hemostasis was obtained with electrocoagulation.,Retinaculum, quadriceps and extensor were repaired with multiple figure-of-eight #1 Vicryl sutures, the subcutaneous tissue with 2-0 and the skin with skin staples. A sterile, bulky compression dressing was placed. The patient was stable on operative release.
---
DESCRIPTION: Right total knee arthroplasty - Osteoarthritis, right knee.

surgery, osteoarthritis, arthroplasty, knee, patella, retinacular parapatellar, total knee arthroplasty, total knee, knee arthroplasty, baseplate, femoral, tibia,

The described procedure is a total knee arthroplasty, a common surgical intervention for osteoarthritis of the knee. While this is a routine and elective procedure, it is major surgery with risks such as infection, blood clots, and complications from anesthesia. It requires significant skill and precision, as well as postoperative care and rehabilitation for successful outcomes. Therefore, while not emergent or life-threatening, it involves significant planning and impacts the patient's quality of life considerably.


Medical Specialty: Surgery
Sample Name: Total Knee Replacement

PREOPERATIVE DIAGNOSIS: ,Degenerative arthritis of the left knee.,POSTOPERATIVE DIAGNOSIS:, Degenerative arthritis of the left knee.,PROCEDURE PERFORMED: , Total left knee replacement on 08/19/03.  The patient also underwent a bilateral right total knee replacement in the same sitting and that will be dictated by Dr. X.,TOURNIQUET TIME: , 76 minutes.,BLOOD LOSS: , 150 cc.,ANESTHESIA:  ,General.,IMPLANT USED FOR PROCEDURE:,  NexGen size F femur on the left with #8 size peg tibial tray, a #12 mm polyethylene insert and this a cruciate retaining component.  The patella on the left was not resurfaced.,GROSS INTRAOPERATIVE FINDINGS: , Degenerative ware of three compartments of the trochlea, the medial, as well as the lateral femoral condyles as well was the plateau.  The surface of the patella was with a minimal ware and minimal osteophytes and we decided not to resurface the patellar component.,HISTORY:  ,This is a 69-year-old male with complaints of bilateral knee pain for several years and increased intensity in the past several months where it has affected his activities of daily living.  He attempted conservative treatment, which includes anti-inflammatory medications as well as cortisone and Synvisc.  This has only provided him with temporary relief.  It is for that reason, he is elected to undergo the above-named procedure.,All risks as well as complications were discussed with the patient, which include, but are not limited to infection, deep vein thrombosis, pulmonary embolism, need for further surgery, and further pain.  He has agreed to undergo this procedure and a consent was obtained preoperatively.,PROCEDURE: , The patient was wheeled back to operating room #2 at ABCD General Hospital on 08/19/03 and was placed supine on the operating room table.  At this time, a nonsterile tourniquet was placed on the left upper thigh, but not inflated.  An Esmarch was then used to exsanguinate the extremity and the left extremity was then prepped and draped in the usual sterile fashion for this procedure.  The tourniquet was then inflated to 325 mmHg.  At this time, a standard midline incision was made towards the total knee.  We did discuss preoperatively for a possible unicompartmental knee replacement for this patient, but he did have radiographic evidence of chondrocalcinosis of the lateral meniscus.  We did start off with a small midline skin incision in case we were going to do a unicompartmental.  Once we exposed the medial parapatellar mini-arthrotomy and visualized the lateral femoral condyle, we decided that this patient would not be an optimal candidate for unicompartmental knee replacement.  It is for this reason that we extended the incision and underwent with the total knee replacement.  Once the full medial parapatellar arthrotomy was performed with the subperiosteal dissection of the proximal tibia in order to evert the patella.  Once the patella was everted, we then used a drill to cannulate the distal femoral canal in order to place the intramedullary guide.  A Charnley awl was then used to remove all the intramedullary contents and they were removed from the knee.  At this time, a femoral sizer was then placed with reference to the posterior condyles and we measured a size F. Once this was performed, three degrees of external rotation was then drilled into the condyle in alignment with the epicondyles of the femur.  At this time, the intramedullary guide was then inserted and placed in three degrees of external rotation.  Our anterior cutting guide was then placed and an anterior cut was performed with careful protection of the soft tissues.  Next, this was removed and the distal femoral cutting guide was then placed in five degrees of valgus.  This was pinned to the distal femur and with careful protection of the collateral ligaments, a distal femoral cut was performed.  At this time, the intramedullary guide was removed and a final cutting block was placed.  This was placed in the center on the distal femur with 1 mm to 2 mm laterally translated for better patellar tracking.  At this time, the block was pinned and screwed in place with spring pins with careful protection of the soft tissues.  An oscillating saw was then used to resect the posterior and anterior cutting blocks with anterior and posterior chamfer as well as the notch cut.  Peg holes were then drilled.,The block was then removed and an osteotome was then used to remove all the bony cut pieces.  At this time with a better exposure of the proximal tibia, we placed external tibial guide.  This was placed with longitudinal axis of the tibia and carefully positioned in order to obtain an optimal cut for the proximal tibia.  At this time with careful soft tissue retraction and protection, an oscillating saw was used to make a proximal tibial osteotomy.  Prior to the osteotomy, the cut was checked with a depth gauge in order to assure appropriate bony resection.  At this time, a _blunt Kocher and Bovie cautery were used to remove the proximal tibial cut, which had soft tissue attachments.  Once this was removed, we then implanted our trial components of size F to the femur and a size 8 mm tibial tray with 12 mm plastic articulating surface.  The knee was taken through range of motion and revealed excellent femorotibial articulation.  The patella did tend to sublux somewhat laterally with extremes of flexion and it was for this reason, we performed a minimal small incision lateral retinacular release.  Distal lateral patella was tracked more uniformly within the patellar groove of the prosthesis.  At this time, an intraoperative x-ray was performed, which revealed excellent alignment with no varus angulation especially of the whole femur and tibial alignment and tibial cut.  At this time, the prosthesis was removed.  A McGill retractor was then reinserted and replaced peg tibial tray in order to peg the proximal tibia.  Once the drill holes were performed, we then copiously irrigated the wound and then suctioned it dry to get ready and prepped for cementation of the drilled components.  At this time, polymethyl methacrylate cement was then mixed.  The cement was placed on the tibial surface as well as the underneath surface of the component.  The component was then placed and impacted with excess cement removed.  In a similar fashion, the femoral component was also placed.  A 12 mm plastic tray was then placed and the leg held in full extension and compression in order to obtain adequate bony cement content.  Once the cement was fully hardened, the knee was flexed and a small osteotome was used to remove any extruding cement from around the prosthesis of the bone.  Once this was performed, copious irrigation was used to irrigate the wound and the wound was then suctioned dry.  The knee was again taken through range of motion with a 12 mm plastic as well as #14.  The #14 appeared to be a bit too tight especially in extremes of flexion.  We decided to go with a #12 mm polyethylene tray.  At this time, this was placed to the tibial articulation and then left in place.  This was rechecked with careful attention to detail with checking no soft tissue interpositioned between the polyethylene tray and the metal tray of the tibia.  The knee was again taken through range of motion and revealed excellent tracking of the patella with good femur and tibial contact.  A drain was placed and cut to length.,At this time, the knee was irrigated and copiously suction dried.  #1-0 Ethibond suture was then used to approximate the medial parapatellar arthrotomy in figure-of-eight fashion.  A tight capsular closure was performed.  This was reinforced with a #1-0 running Vicryl suture.  At this time, the knee was again taken through range of motion to assure tight capsular closure.  At this time, copious irrigation was used to irrigate the superficial wound.  #2-0 Vicryl was used to approximate the wound with figure-of-eight inverted suture.  The skin was then approximated with staples.  The leg was then cleansed.  Sterile dressing consisting of Adaptic, 4x4, ABDs, and Kerlix roll were then applied.  At this time, the patient was extubated and transferred to recovery in stable condition.  Prognosis is good for this patient.
---
DESCRIPTION: Total left knee replacement.  Degenerative arthritis of the left knee.  Degenerative ware of three compartments of the trochlea, the medial, as well as the lateral femoral condyles as well was the plateau.

surgery, degenerative arthritis, nexgen, polyethylene, cruciate, total knee replacement, proximal tibia, knee replacement, femoral, cutting, tibial, knee, arthritis, femur, cementation,

This situation involves a surgical procedure, specifically a total knee replacement, which is inherently high-stakes. Any surgery carries risks such as infection, deep vein thrombosis, or complications from anesthesia. The fact that this is a joint replacement adds complexity and potential for significant impact on the patient's mobility and quality of life. The procedure involves careful intraoperative decisions and precision to ensure the best outcome, further elevating the stakes.