Medical Specialty: Surgery
Sample Name: Repair of Canthal & Lid Defect

PREOPERATIVE DIAGNOSIS: , Status post Mohs resection epithelial skin malignancy left lower lid, left lateral canthus, and left upper lid.,POSTOPERATIVE DIAGNOSIS: , Status post Mohs resection epithelial skin malignancy left lower lid, left lateral canthus, and left upper lid.,PROCEDURES:,1.  Repair of one-half full-thickness left lower lid defect by tarsoconjunctival pedicle flap from left upper lid to left lower lid.,2.  Repair of left upper and lateral canthal defect by primary approximation to lateral canthal tendon remnant.,ASSISTANT: , None.,ANESTHESIA: , Attended local by Strickland and Associates.,COMPLICATIONS: , None.,DESCRIPTION OF PROCEDURE: , The patient was taken to the operating room, placed in supine position.  Dressing was removed from the left eye, which revealed the defect as noted above.  After systemic administration of alfentanil, local anesthetic was infiltrated into the left upper lid, left lateral canthus, and left lower eyelid.  The patient was prepped and draped in the usual ophthalmic fashion.  Protective scleral shell was placed in the left eye.  A 4-0 silk traction sutures placed through the upper eyelid margin.  The medial aspect of the remaining lower eyelid was freshened with straight iris scissors and fibrin was removed from the inferior aspect of the wound.  The eyelid was everted and a tarsoconjunctival pedicle flap was developed by incision of the tarsus approximately 3-1/2-4 mm from the lid margin the full width of the eyelid.  Relaxing incisions were made both medially and laterally and Mueller's muscle was subsequently dissected free from the superior tarsal border.  The tarsoconjunctival pedicle was then anchored to the lateral orbital rim with two interrupted 6-0 Vicryl sutures and one 4-0 Vicryl suture.  The protective scleral shell was removed from the eye.  The medial aspect of the eyelid was advanced temporally.  The tarsoconjunctival pedicle was then cut to size and the tarsus was anchored to the medial aspect of the eyelid with multiple interrupted 6-0 Vicryl sutures.  The conjunctiva and lower lid retractors were attached to the advanced tarsal edge with a running 7-0 Vicryl suture.  The upper eyelid wound was present.  It was advanced to the advanced tarsoconjunctival pedicle temporally.  The conjunctival pedicle was slightly trimmed to make a lateral canthal tendon and the upper eyelid was advanced to the tarsoconjunctival pedicle temporally with an interrupted 6-0 Vicryl suture, it was then secured to the lateral orbital rim with two interrupted 6-0 Vicryl sutures.  Skin muscle flap was then elevated, was draped superiorly and nasally and was anchored to the medial aspect of the eyelid with interrupted 7-0 Vicryl sutures.  Burrows triangle was removed as was necessary to create smooth wound closure, which was closed with interrupted 7-0 Vicryl suture.  Temporally the orbicularis was resuspended from the advanced skin muscle flap with interrupted 6-0 Vicryl suture to the periosteum overlying the lateral orbital rim.  The skin muscle flap was secured to the underlying tarsoconjunctival pedicle with vertical mattress sutures of 7-0 Vicryl followed by wound closure temporally with interrupted 7-0 Vicryl suture with removal of a burrow's triangle as was necessary to create smooth wound closure.  Erythromycin ointment was then applied to the eye and to the wound followed by multiple eye pads with moderate pressure.  The patient tolerated the procedure well and left the operating room in excellent condition.  There were no apparent complications.
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DESCRIPTION: Repair of one-half full-thickness left lower lid defect by tarsoconjunctival pedicle flap from left upper lid to left lower lid and repair of left upper and lateral canthal defect by primary approximation to lateral canthal tendon remnant.

surgery, mohs resection epithelial skin, lid left lateral canthus, lateral canthal defect, tarsoconjunctival pedicle flap, lateral canthal tendon, skin muscle flap, interrupted vicryl sutures, canthal defect, mohs resection, lid defect, pedicle flap, canthal tendon, lateral canthus, upper eyelid, lateral orbital, eyelid, vicryl, sutures, repair, eye, canthal, defect, tarsoconjunctival, pedicle

This surgical procedure involves the repair of canthal and eyelid defects following a Mohs resection for skin cancer. While the procedure is precise and involves surgical techniques to restore the eyelid and canthal area, it does not seem to involve life-threatening or critical emergency health concerns. However, it is not without importance because it deals with facial reconstruction and has implications for the patient's functional outcomes, such as vision protection and eyelid mobility, as well as cosmetic appearance. In context, it necessitates precision and skill but is not typical of high-risk surgery, such as those involving major organ systems or vital life functions.


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

Medical Specialty: Surgery
Sample Name: Repeat C-section

PREOPERATIVE DIAGNOSES:,1.  Intrauterine pregnancy at 39 weeks.,2.  History of previous cesarean section x2.  The patient desires a repeat section.,3.  Chronic hypertension.,4.  Undesired future fertility.  The patient desires permanent sterilization.,POSTOPERATIVE DIAGNOSES:,1.  Intrauterine pregnancy at 39 weeks.,2.  History of previous cesarean section x2.  The patient desires a repeat section.,3.  Chronic hypertension.,4.  Undesired future fertility.  The patient desires permanent sterilization.,PROCEDURE PERFORMED:  ,Repeat cesarean section and bilateral tubal ligation.,ANESTHESIA: , Spinal.,ESTIMATED BLOOD LOSS:,  800 mL.,COMPLICATIONS:  ,None.,FINDINGS: , Male infant in cephalic presentation with anteflexed head, Apgars were 2 at 1 minute and 9 at 5 minutes, 9 at 10 minutes, and weight 7 pounds 8 ounces.  Normal uterus, tubes, and ovaries were noted.,INDICATIONS:  ,The patient is a 31-year-old gravida 5, para 4 female, who presented to repeat cesarean section at term.  The patient has a history of 2 previous cesarean sections and she desires a repeat cesarean section, additionally she desires permanent fertilization.  The procedure was described to the patient in detail including possible risks of bleeding, infection, injury to surrounding organs, and the possible need for further surgery and informed consent was obtained.,PROCEDURE NOTE: , The patient was taken to the operating room where spinal anesthesia was administered without difficulty.  The patient was prepped and draped in the usual sterile fashion in the dorsal supine position with a leftward tilt.  A Pfannenstiel skin incision was made with the scalpel and carried through to the underlying layer of fascia using the Bovie.  The fascia was incised in the midline and extended laterally using Mayo scissors.  Kocher clamps were used to elevate the superior aspect of the fascial incision, which was elevated, and the underlying rectus muscles were dissected off bluntly and using Mayo scissors.  Attention was then turned to the inferior aspect of the fascial incision, which in similar fashion was grasped with Kocher clamps, elevated, and the underlying rectus muscles were dissected off bluntly and using the Bovie.  The rectus muscles were dissected in the midline.,The peritoneum was identified and entered using Metzenbaum scissors; this incision was extended superiorly and inferiorly with good visualization of the bladder.  The bladder blade was inserted.  The vesicouterine peritoneum was identified and entered sharply using Metzenbaum scissors.  This incision was extended laterally and the bladder flap was created digitally.  The bladder blade was reinserted.  The lower uterine segment was incised in a transverse fashion using the scalpel and extended using bandage scissors as well as manual traction.,Clear fluid was noted.  The infant was subsequently delivered using a Kelly vacuum due to anteflexed head and difficulty in delivering the infant's head without the Kelly.  The nose and mouth were bulb suctioned.  The cord was clamped and cut.  The infant was subsequently handed to the awaiting nursery nurse.  The placenta was delivered spontaneously intact with a three-vessel cord noted.  The uterus was exteriorized and cleared of all clots and debris.  The uterine incision was repaired in 2 layers using 0 chromic sutures.  Hemostasis was visualized.  Attention was turned to the right fallopian tube, which was grasped with Babcock clamp using a modified Pomeroy method, a 2 cm of segment of tube ligated x2, transected and specimen was sent to pathology.  Attention was then turned to the left fallopian tube, which was grasped with Babcock clamp again using a modified Pomeroy method, a 2 cm segment of tube was ligated x2 and transected.  Hemostasis was visualized bilaterally.  The uterus was returned to the abdomen, both fallopian tubes were visualized and were noted to be hemostatic.  The uterine incision was reexamined and it was noted to be hemostatic.  The pelvis was copiously irrigated.  The rectus muscles were reapproximated in the midline using 3-0 Vicryl.  The fascia was closed with 0 Vicryl suture, the subcutaneous layer was closed with 3-0 plain gut, and the skin was closed with staples.  Sponge, lap, and instrument counts were correct x2.  The patient was stable at the completion of the procedure and was subsequently transferred to the recovery room in stable condition.
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DESCRIPTION: Repeat cesarean section and bilateral tubal ligation.

surgery, bilateral tubal ligation, permanent sterilization, undesired future fertility, repeat cesarean section, intrauterine pregnancy, mayo scissors, kocher clamps, metzenbaum scissors, fallopian tube, babcock clamp, pomeroy method, rectus muscles, cesarean section, intrauterine, cesarean,

This medical scenario involves a repeat C-section along with a bilateral tubal ligation for a patient with a history of chronic hypertension. This type of surgery has inherent risks typical of major surgeries, such as bleeding, infection, and potential injury to surrounding organs. The stakes are particularly high due to the patient's existing medical condition (chronic hypertension) and the nature of the procedures being performed (both a repeat C-section and permanent sterilization). Although the procedure was completed without complications, every surgical case, especially involving anesthesia and childbirth, carries considerable risks. Therefore, I consider this a high-stakes situation due to the complexity, potential for severe outcomes, and the overall critical nature of both the procedures and the condition being managed.

Filled in based on scale_labels and scale_label_confidence


Medical Specialty: Surgery
Sample Name: Resection of Tumor of Scalp

PREOPERATIVE DIAGNOSIS: , Squamous cell carcinoma of the scalp.,POSTOPERATIVE DIAGNOSIS:,  Same.,OPERATION PERFORMED: , Radical resection of tumor of the scalp (CPT 11643).  Excision of tumor from the skull with debridement of the superficial cortex with diamond bur.  Advancement flap closure, with total undermined area 18 centimeters by 16 centimeters (CPT 14300).,ANESTHESIA:,  General endotracheal anesthesia.,INDICATIONS:  ,This is an 81-year-old male who has a large exophytic 7cm lesion of the anterior midline scalp which is biopsy-positive for skin malignancy, specifically, squamous call carcinoma.  This appears to be affixed to the underlying scalp.,PLAN: , Radical resection with frozen sections to clear margins thereafter, with planned reconstruction.,CONSENT:,  I have discussed with the patient the possible risks of bleeding, infection, renal problems, scar formation, injury to muscle, nerves, and possible need for additional surgery with possible recurrence of the patient's carcinoma, with review of detailed informed consent with the patient, who understood, and wished to proceed.,FINDINGS: , The patient had a 7cm large exophytic lesion which appeared to be invasive into the superficial table of the skull.  The final periosteal margin which centrally appeared was positive for carcinoma.  The final margins peripherally were all negative.,DESCRIPTION OF PROCEDURE IN DETAIL: , The patient was taken to the operating room and there was placed supine on the operating room table.,General endotracheal anesthesia was administered after endotracheal tube intubation was performed by the Anesthesia Service personnel.  The patient was thereafter prepped and draped in the usual sterile manner using Betadine Scrub and Betadine paint.  Thereafter, the local anesthesia was injected into the area around the tumor.  A **** type excision was planned down to the periosteum.  A supraperiosteal radical resection was performed.,It was obvious that there was tumor at the deep margin, involving the periosteum.  The edges were marked along the four quadrants, at the 12 o'clock, 3 o'clock, 6 o'clock, and the 9 o'clock positions, and these were sent for frozen section evaluation.  Frozen section revealed positive margins at one end of the resection.  Therefore, an additional circumferential resection was performed and the final margins were all negative.,Following completion, the deep periosteal margin was resected.  The circumferential periosteal margins were noted to be negative; however, centrally, there was a small area which showed tumor eroding into the superficial cortex of the skull.  Therefore, the Midas Rex drill was utilized to resect approximately 1-2 mm of the superficial cortex of the bone at the area where the positive margin was located.  Healthy bone was obtained; however, it did not enter the diploic or marrow-containing bone in the area.  Therefore, no bong margin was taken.  However, at the end of the procedure, it did not appear that the residual bone had any residual changes consistent with carcinoma.,Following completion of the bony resection, the area was irrigated with copious amounts of saline.  Thereafter, advancement flaps were created, both on the left and the right side of the scalp, with the total undermined area being approximately 18cm by 16cm.  The galea was incised in multiple areas, to provide for additional mobilization of the tissue.  The tissue was closed under tension with 3-0 Vicryl suture deep in the galea and surgical staples superficially.,The patient was awakened from anesthetic, was extubated and was taken to the recovery room in stable condition.,DISPOSITION:,  The patient was discharged to home with antibiotics and analgesics, to follow-up in approximately one week.,NOTE: , The final margins of both periosteal, as well as skin were negative circumferentially, around the tumor.  The only positive margin was deep, which was a periosteal margin and bone underlying it was partially resected, as was indicated above.
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DESCRIPTION: Radical resection of tumor of the scalp, excision of tumor from the skull with debridement of the superficial cortex with diamond bur, and advancement flap closure.

surgery, squamous cell carcinoma of the scalp, squamous cell carcinoma, radical resection, margin, midas rex drill, radical resection of tumor, resection of tumor, endotracheal anesthesia, superficial cortex, margins, periosteum, skull, cortex, periosteal, scalp, resection, tumor,

The case involves the surgical resection of a squamous cell carcinoma from the scalp, a procedure inherently risky due to potential complications such as bleeding, infection, nerve injury, and incomplete tumor removal. Importantly, the patient's age (81 years) adds complexity due to the potential for decreased healing capacity and increased sensitivity to anesthesia. The documentation outlines thorough surgical procedures, indicating careful handling of margins to ensure no residual carcinoma. This demonstrates that the stakes are relatively high due to the nature of the disease, the complexity of the surgery, and the discussed potential risks, highlighting the need for surgical precision and postoperative care.


Medical Specialty: Surgery
Sample Name: Release of A1 Pulley - 1

PREOPERATIVE DIAGNOSIS: , Stenosing tendinosis, right thumb (trigger finger).,POSTOPERATIVE DIAGNOSIS: , Stenosing tendinosis, right thumb (trigger finger).,PROCEDURE PERFORMED:,  Release of A1 pulley, right thumb.,ANESTHESIA:,  IV regional with sedation.,COMPLICATIONS: , None.,ESTIMATED BLOOD LOSS: , Minimal.,TOURNIQUET TIME: , Approximately 20 minutes at 250 mmHg.,INTRAOPERATIVE FINDINGS: , There was noted to be thickening of the A1 pulley.  There was a fibrous nodule noted within the flexor tendon of the thumb, which caused triggering sensation to the thumb.,HISTORY:  ,This is a 51-year-old right hand dominant female with a longstanding history of pain as well as locking sensation to her right thumb.  She was actually able to spontaneously trigger the thumb.  She was diagnosed with stenosing tendinosis and wishes to proceed with release of A1 pulley.  All risks and benefits of the surgery was discussed with her at length.  She was in agreement with the above treatment plan.,PROCEDURE:  ,On 08/21/03, she was taken to operating room at ABCD General Hospital and placed supine on the operating table.  A regional anesthetic was applied by the Anesthesia Department.  Tourniquet was placed on her proximal arm.  The upper extremity was sterilely prepped and draped in the usual fashion.,An incision was made over the proximal crease of the thumb.  Subcuticular tissues were carefully dissected.  Hemostasis was controlled with electrocautery.  The nerves were identified and retracted throughout the entire procedure.  The fibers of the A1 pulley were identified.  They were sharply dissected to release the tendon.  The tendon was then pulled up into the wound and inspected.  There was no evidence of gross tear noted.  Fibrous nodule was noted within the tendon itself.  There was no evidence of continuous locking.  Once release of the pulley had been performed, the wound was copiously irrigated.  It was then reapproximated using #5-0 nylon simple interrupted and horizontal mattress sutures.  Sterile dressing was applied to the upper extremity.  Tourniquet was deflated.  It was noted that the thumb was warm and pink with good capillary refill.  The patient was transferred to Recovery in apparent stable and satisfactory condition.  Prognosis is fair.
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DESCRIPTION: Release of A1 pulley, right thumb.   Stenosing tendinosis, right thumb (trigger finger).  There was noted to be thickening of the A1 pulley.  There was a fibrous nodule noted within the flexor tendon of the thumb, which caused triggering sensation to the thumb.

surgery, release of a1 pulley, tendinosis, thumb, flexor tendon, trigger finger, fibrous nodule, stenosing tendinosis, tourniquet, stenosing, tendon, release, pulley

The situation involves a surgical procedure for the release of the A1 pulley in the right thumb due to stenosing tendinosis, commonly known as trigger finger. This is generally a routine and low-risk orthopedic surgery with minimal complications, as noted by the absence of intraoperative complications and minimal blood loss. The procedure was successfully completed, and the patient was transferred to recovery in stable condition. While surgery always carries inherent risks, in the context of surgeries, this is a relatively minor procedure with a low risk of severe complications.


Medical Specialty: Surgery
Sample Name: Radioactive Plaque - Removal

PREOPERATIVE DIAGNOSIS: , Radioactive plaque macular edema.,POSTOPERATIVE DIAGNOSIS:,  Radioactive plaque macular edema.,TITLE OF OPERATION:,  Removal of radioactive plaque, right eye with lateral canthotomy.,OPERATIVE PROCEDURE IN DETAIL: , The patient was prepped and draped in the usual manner for a local eye procedure.  Then a retrobulbar injection of 2% Xylocaine was performed.  A lid speculum was applied and the conjunctiva was opened 4 mm from the limbus.  A 2-0 traction suture was passed around the insertion of the lateral rectus and the temporal one-half of the globe was exposed.  Next, the plaque was identified and the two scleral sutures were removed.  The plaque was gently extracted and the conjunctiva was re-sutured with 6-0 catgut, following removal of the traction suture.  The fundus was inspected with direct ophthalmoscopy.  An eye patch was applied following Neosporin solution irrigation.  The patient was sent to the recovery room in good condition.  A lateral canthotomy had been done.
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DESCRIPTION: Radioactive plaque macular edema.  Removal of radioactive plaque, right eye with lateral canthotomy.  A lid speculum was applied and the conjunctiva was opened 4 mm from the limbus.  A 2-0 traction suture was passed around the insertion of the lateral rectus and the temporal one-half of the globe was exposed.

surgery, conjunctiva, eye patch, ophthalmoscopy, radioactive plaque, traction, suture, eye, radioactive, plaque

The situation involves the removal of a radioactive plaque from a patient's eye, a procedure that requires surgical precision and care. Any mistake could potentially result in complications, such as damage to the eye or the worsening of symptoms. Although this is a planned surgical procedure and not an emergency, surgeries involving the eye inherently carry significant stakes due to the risk of vision loss and the complexity of the operation. Therefore, this situation is high-stakes as it directly impacts a critical sense and requires highly skilled execution.


Medical Specialty: Surgery
Sample Name: Radiofrequency Thermocoagulation - 1

PROCEDURE: , Radiofrequency thermocoagulation of bilateral lumbar sympathetic chain.,ANESTHESIA: , Local sedation.,VITAL SIGNS: , See nurse's notes.,COMPLICATIONS: , None.,DETAILS OF PROCEDURE:  ,INT was placed.  The patient was in the operating room in the prone position with the back prepped and draped in a sterile fashion.  The patient was given sedation and monitored.  Lidocaine 1.5% for skin wheal was made 10 cm from the midline to the bilateral L2 distal vertebral body.  A 20-gauge, 15 cm SMK needle was then directed using AP and fluoroscopic guidance so that the tip of the needle was noted to be along the distal one-third and anterior border on the lateral view and on the AP view the tip of the needle was inside the lateral third of the border of the vertebral body.  At this time a negative motor stimulation was obtained.  Injection of 10 cc of 0.5% Marcaine plus 10 mg of Depo-Medrol was performed. Coagulation was then carried out for 90oC for 90 seconds.  At the conclusion of this, the needle under fluoroscopic guidance was withdrawn approximately 5 mm where again a negative motor stimulation was obtained and the sequence of injection and coagulation was repeated.  This was repeated one more time with a 5 mm withdrawal and coagulation.,At that time, attention was directed to the L3 body where the needle was placed to the upper one-third/distal two-thirds junction and the sequence of injection, coagulation, and negative motor stimulation with needle withdrawal one time of a 5 mm distance was repeated.  There were no compilations from this.  The patient was discharged to operating room recovery in stable condition.
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DESCRIPTION: Radiofrequency thermocoagulation of bilateral lumbar sympathetic chain.

surgery, lumbar sympathetic chain, vertebral body, radiofrequency thermocoagulation, motor stimulation, thermocoagulation, radiofrequency, coagulation, needle,

The described procedure involves a surgery on the lumbar sympathetic chain using radiofrequency thermocoagulation, which is a specialized technique requiring precision and proper execution to avoid nerve damage. While complications were not noted in this instance, the procedure inherently involves risks associated with surgery and nerve interventions. The stakes include patient safety and potential impact on neurological function if not executed correctly, albeit in this specific scenario, it was completed without complications suggesting good management of risks.


Medical Specialty: Surgery
Sample Name: Radiofrequency Ablation

PROCEDURE: , Bilateral L5, S1, S2, and S3 radiofrequency ablation.,INDICATION: , Sacroiliac joint pain.,INFORMED CONSENT: , The risks, benefits and alternatives of the procedure were discussed with the patient.  The patient was given opportunity to ask questions regarding the procedure, its indications and the associated risks.,The risk of the procedure discussed include infection, bleeding, allergic reaction, dural puncture, headache, nerve injuries, spinal cord injury, and cardiovascular and CNS side effects with possible of vascular entry of medications.  I also informed the patient of potential side effects or reactions to the medications potentially used during the procedure including sedatives, narcotics, nonionic contrast agents, anesthetics, and corticosteroids.,The patient was informed both verbally and in writing.  The patient understood the informed consent and desired to have the procedure performed.,PROCEDURE: , Oxygen saturation and vital signs were monitored continuously throughout the procedure.  The patient remained awake throughout the procedure in order to interact and give feedback.  The x-ray technician was supervised and instructed to operate the fluoroscopy machine.,The patient was placed in a prone position on the treatment table with a pillow under the chest and head rotated.  The skin over and surrounding the treatment area was cleaned with Betadine.  The area was covered with sterile drapes, leaving a small window opening for needle placement.  Fluoroscopy was used to identify the bony landmarks of the sacrum and the sacroiliac joints and the planned needle approach.  The skin, subcutaneous tissue, and muscle within the planned approach were anesthetized with 1% Lidocaine.,With fluoroscopy, a 20 gauge 10-mm bent Teflon coated needle was gently guided into the groove between the SAP and the sacrum for the dorsal ramus of L5 and the lateral border of the posterior sacral foramen, for the lateral branches of S1, S2, and S3.  Also, fluoroscopic views were used to ensure proper needle placement.,The following technique was used to confirm correct placement.  Motor stimulation was applied at 2 Hz with 1 millisecond duration.  No extremity movement was noted at less than 2 volts.  Following this, the needle trocar was removed and a syringe containing 1% lidocaine was attached.  At each level, after syringe aspiration with no blood return, 0.5 mL of 1% lidocaine was injected to anesthetize the lateral branch and the surrounding tissue.  After completion, a lesion was created at that level with a temperature of 80 degrees for 90 seconds.,All injected medications were preservative free.  Sterile technique was used throughout the procedure.,ADDITIONAL DETAILS:  ,None.,COMPLICATIONS: , None.,DISCUSSION: , Post-procedure vital signs and oximetry were stable.  The patient was discharged with instructions to ice the injection site as needed for 15-20 minutes as frequently as twice per hour for the next day and to avoid aggressive activities for 1 day.  The patient was told to resume all medications.  The patient was told to be in relative rest for 1 day but then could resume all normal activities.,The patient was instructed to seek immediate medical attention for shortness of breath, chest pain, fever, chills, increased pain, weakness, sensory or motor changes, or changes in bowel or bladder function.,Follow up appointment was made at PM&R Spine Clinic in approximately one to two weeks.
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DESCRIPTION: Bilateral L5, S1, S2, and S3 radiofrequency ablation for sacroiliac joint pain.  Fluoroscopy was used to identify the bony landmarks of the sacrum and the sacroiliac joints and the planned needle approach.  The skin, subcutaneous tissue, and muscle within the planned approach were anesthetized with 1% Lidocaine.

surgery, sacroiliac joint pain, sacroiliac, teflon coated needle, fluoroscopy, needle placement, radiofrequency ablation, ablation, tissue, lidocaine, needle,

The situation involves a medical procedure known as radiofrequency ablation, which is performed to alleviate sacroiliac joint pain. This is a specialized surgical procedure requiring precision and entails certain risks such as infection, bleeding, nerve injuries, and more. Although these risks are serious, the procedure is standard in pain management and generally has a favorable safety profile. The document shows proper informed consent and post-procedure care, indicating the situation is well-managed. However, due to the inherent risks of spinal procedures and the potential severe consequences if complications occur, the stakes are significant.


Medical Specialty: Surgery
Sample Name: Radical Mastectomy - 1

PROCEDURE PERFORMED: , Modified radical mastectomy.,ANESTHESIA: , General endotracheal tube.,PROCEDURE:  ,After informed consent was obtained, the patient was brought to the operative suite and placed supine on the operating room table.  General endotracheal anesthesia was induced without incident.  The patient was prepped and draped in the usual sterile manner.  Care was taken to ensure that the arm was placed in a relaxed manner away from the body to facilitate exposure and to avoid nerve injury.,An elliptical incision was made to incorporate the nipple-areolar complex and the previous biopsy site.  The skin incision was carried down to the subcutaneous fat but no further.  Using traction and counter-traction, the upper flap was dissected from the chest wall medially to the sternal border, superiorly to the clavicle, laterally to the anterior border of the latissimus dorsi muscle, and superolaterally to the insertion of the pectoralis major muscle.  The lower flap was dissected in a similar manner down to the insertion of the pectoralis fascia overlying the fifth rib medially and laterally out to the latissimus dorsi.  Bovie electrocautery was used for the majority of the dissection and hemostasis tying only the large vessels with 2-0 Vicryl.  The breast was dissected from the pectoralis muscle beginning medially and progressing laterally removing the pectoralis fascia entirely.  Once the lateral border of the pectoralis major muscle was identified, the pectoralis muscle was retracted medially and the interpectoral fat was removed with the specimen.,The axillary dissection was then begun by incising the fascia overlying axilla proper allowing visualization of the axillary vein.  The highest point of axillary dissection was then marked with a long stitch for identification by the surgical pathologist.  The axilla was then cleared of its contents by sharp dissection.  Small vessels entering the axillary vein were clipped and divided.  The axilla was cleared down to the chest wall, and dissection was continued laterally to the subscapular vein.  The long thoracic nerve was cleared identified lying against the chest and was carefully preserved.  The long thoracic nerve represented the posterior most aspect of the dissection.  As the axillary contents were dissected in the posterolateral axilla, the thoracodorsal nerve was identified and carefully preserved.  The dissection continued caudally until the entire specimen was freed and delivered from the operative field.  Copious water lavage was used to remove any debris, and hemostasis was obtained with Bovie electrocautery.,Two Jackson-Pratt drains were inserted through separate stab incisions below the initial incision and cut to fit.  The most posterior of the 2 was directed into the axilla and the other directed anteriorly across the pectoralis major.  These were secured to the skin using 2-0 silk, which was Roman-sandaled around the drain.,The skin incision was approximated with skin staples.  A dressing was applied.  The drains were placed on "grenade" suction.  All surgical counts were reported as correct.,Having tolerated the procedure well, the patient was subsequently extubated and taken to the recovery room in good and stable condition.
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DESCRIPTION: Modified radical mastectomy.  An elliptical incision was made to incorporate the nipple-areolar complex and the previous biopsy site.  The skin incision was carried down to the subcutaneous fat but no further.

surgery, latissimus dorsi muscle, pectoralis major muscle, pectoralis fascia, axillary vein, thoracic nerve, radical mastectomy, pectoralis major, axillary, incision, mastectomy, fascia, muscle, pectoralis,

The situation involves a surgical procedure, specifically a modified radical mastectomy, which is a significant operation often performed for breast cancer treatment. Surgery inherently involves risks such as infection, bleeding, and complications from anesthesia. The stakes are high because it directly involves patient health and outcomes. Post-operative care, including drainage management, is also crucial to prevent complications. Given the complexity and implications for the patient's health, it is a high-stakes situation.


Medical Specialty: Surgery
Sample Name: Pyeloureteroscopy

PREOPERATIVE DIAGNOSES: , Left obstructed renal ureteropelvic junction obstruction status post pyeloplasty, percutaneous procedure, and pyeloureteroscopy x2, and status post Pseudomonas pyelonephritis x6, renal insufficiency, and solitary kidney.,POSTOPERATIVE DIAGNOSES:,  Left obstructed renal ureteropelvic junction obstruction status post pyeloplasty, percutaneous procedure, and pyeloureteroscopy x2, and status post Pseudomonas pyelonephritis x6, renal insufficiency, and solitary kidney.,PROCEDURE:  ,Cystoscopy under anesthesia, retrograde and antegrade pyeloureteroscopy, left ureteropelvic junction obstruction, difficult and open renal biopsy.,ANESTHESIA:  ,General endotracheal anesthetic with a caudal block x2.,FLUIDS RECEIVED:  ,1000 mL crystalloid.,ESTIMATED BLOOD LOSS:  ,Less than 10 mL.,SPECIMENS: , Tissue sent to pathology is a renal biopsy.,ABNORMAL FINDINGS: , A stenotic scarred ureteropelvic junction with dilated ureter and dilated renal pelvis.,TUBES AND DRAINS:  ,A 10-French silicone Foley catheter with 3 mL in balloon and a 4.7-French ureteral double J-stent multilength.,INDICATIONS FOR OPERATION:  ,The patient is a 3-1/2-year-old boy, who has a solitary left kidney with renal insufficiency with creatinine of 1.2, who has had a ureteropelvic junction repair performed by Dr. Chang.  It was subsequently obstructed with multiple episodes of pyelonephritis, two percutaneous tube placements, ureteroscopy with balloon dilation of the system, and continued obstruction.  Plan is for co surgeons due to the complexity of the situation and the solitary kidney to do surgical procedure to correct the obstruction.,DESCRIPTION OF OPERATION:  ,The patient was taken to the operative room.  Surgical consent, operative site, and patient identification were verified.  Dr. X and Dr. Y both agreed upon the procedures in advance.  Dr. Y then, once the patient was anesthetized, requested IV antibiotics with Fortaz, the patient had a caudal block placed, and he was then placed in lithotomy position.  Dr. Y then calibrated the urethra with the bougie a boule to 8, 10, and up to 12 French.  The 9.5-French cystoscope sheath was then placed within the patient's bladder with the offset scope, and his bladder had no evidence of cystitis.  I was able to locate the ureteral orifice bilaterally, although no urine coming from the right.  We then placed a 4-French ureteral catheter into the ureter as far as we could go.  An antegrade nephrostogram was then performed, which shows that the contrast filled the dilated pelvis, but did not go into the ureter.  A retrograde was performed, and it was found that there was a narrowed band across the two.  Upon draining the ureter allowing to drain to gravity, the pelvis which had been clamped and its nephrostomy tube did not drain at all.  Dr. Y then placed a 0.035 guidewire into the ureter after removing the 4-French catheter and then placed a 4.7-French double-J catheter into the ureter as far as it would go allowing it to coil in the bladder.  Once this was completed, we then removed the cystoscope and sheath, placed a 10-French Foley catheter, and the patient was positioned by Dr. X and Dr. Y into the flank position with the left flank up after adequate padding on the arms and legs as well as a brachial plexus roll.  He was then sterilely prepped and draped.  Dr. Y then incised the skin with a 15-blade knife through the old incision and then extended the incision with curved mosquito clamp and Dr. X performed cautery of the areas advanced to be excised.  Once this was then dissected, Dr. Y and Dr. X divided the lumbosacral fascia; at the latissimus dorsi fascia, posterior dorsal lumbotomy maneuver using the electrocautery; and then using curved mosquito clamps __________.  At this point, Dr. X used the cautery to enter the posterior retroperitoneal space through the posterior abdominal fascia.  Dr. Y then used the curved right angle clamp and dissected around towards the ureter, which was markedly adherent to the base of the retroperitoneum.  Dr. X and Dr. Y also needed dissection on the medial and lateral aspects with Dr. Y being on the lateral aspect of the area and Dr. X on the medial to get an adequate length of this.  The tissue was markedly inflamed and had significant adhesions noted.  The patient's spermatic vessels were also in the region as well as the renal vessels markedly scarred close to the ureteropelvic junction.  Ultimately, Dr. Y and Dr. X both with alternating dissection were able to dissect the renal pelvis to a position where Dr. Y put stay sutures and a 4-0 chromic to isolate the four quadrant area where we replaced the ureter.  Dr. X then divided the ureter and suture ligated the base, which was obstructed with a 3-0 chromic suture.  Dr. Y then spatulated the ureter for about 1.5 cm, and the stent was gently delivered in a normal location out of the ureter at the proximal and left alone in the bladder.  Dr. Y then incised the renal pelvis and dissected and opened it enough to allow the new ureteropelvic junction repair to be performed.  Dr. Y then placed interrupted sutures of 5-0 Monocryl at the apex to repair the most dependent portion of the renal pelvis, entered the lateral aspect, interrupted sutures of the repair.  Dr. X then was able to without much difficulty do interrupted sutures on the medial aspect.  The stent was then placed into the bladder in the proper orientation and alternating sutures by Dr. Y and Dr. X closed the ureteropelvic junction without any evidence of leakage.  Once this was complete, we removed the extra stay stitches and watched the ureter lay back into the retroperitoneum in a normal position without any kinking in apparently good position.  This opening was at least 1.5 cm wide.  Dr. Y then placed 2 stay sutures of 2-0 chromic in the lower pole of the kidney and then incised wedge biopsy and excised the biopsy with a 15-blade knife and curved iris scissors for renal biopsy for determination of renal tissue health.  Electrocautery was used on the base.  There was no bleeding, however, and the tissue was quite soft.  Dermabond and Gelfoam were placed, and then Dr. Y closed the biopsy site over with thrombin-Gelfoam using the 2-0 chromic stay sutures.  Dr. X then closed the fascial layers with running suture of 3-0 Vicryl in 3 layers.  Dr. Y closed the Scarpa fascia and the skin with 4-0 Vicryl and 4-0 Rapide respectively.  A 4-0 nylon suture was then placed by Dr. Y around the previous nephrostomy tube, which was again left clamped.  Dermabond tissue adhesive was placed over the incision and then a dry sterile dressing was placed by Dr. Y over the nephrostomy tube site, which was left clamped, and the patient then had a Foley catheter placed in the bladder.  The Foley catheter was then taped to his leg.  A second caudal block was placed for anesthesia, and he is in stable condition upon transfer to recovery room.
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DESCRIPTION: Cystoscopy under anesthesia, retrograde and antegrade pyeloureteroscopy, left ureteropelvic junction obstruction, difficult and open renal biopsy.

surgery, cystoscopy, pyeloureteroscopy, ureteropelvic junction obstruction, pseudomonas pyelonephritis, renal insufficiency, fortaz, ureteropelvic junction repair, nephrostomy tube, renal biopsy, renal pelvis, foley catheter, ureteropelvic junction, renal, ureteropelvic,

The situation described involves a surgical procedure on a very young child (3.5 years old) with a solitary kidney, facing complications such as ureteropelvic junction obstruction, previous episodes of pyelonephritis, renal insufficiency, and a complex medical history including previous surgeries. The stakes are high because any failure or complication during surgery could have severe implications for the child's only functioning kidney and overall health. The procedure involves multiple specialists and is detailed, highlighting its complexity and critical nature.


Medical Specialty: Surgery
Sample Name: Punch Biopsy - 2

PREOPERATIVE DIAGNOSIS:,  Worrisome skin lesion, left hand.,POSTPROCEDURE DIAGNOSIS:,  Worrisome skin lesion, left hand.,PROCEDURE:,  The patient gave informed consent for his procedure.  After informed consent was obtained, attention was turned toward the area of interest, which was prepped and draped in the usual sterile fashion.,Local anesthetic medication was infiltrated around and into the area of interest.  There was an obvious skin lesion there and this gentleman has a history of squamous cell carcinoma.  A punch biopsy of the worrisome skin lesion was obtained with a portion of the normal tissue included.  The predominant portion of the biopsy was of the lesion itself.,Lesion was removed.  Attention was turned toward the area.  Pressure was held and the area was hemostatic.,The skin and the area were closed with 5-0 nylon suture.  All counts were correct.  The procedure was closed.  A sterile dressing was applied.  There were no complications.  The patient had no neurovascular deficits, etc., after this minor punch biopsy procedure.,
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DESCRIPTION: Worrisome skin lesion.  A punch biopsy of the worrisome skin lesion was obtained.  Lesion was removed.

surgery, skin lesion, squamous cell carcinoma, punch biopsy,

This case involves a patient with a worrisome skin lesion, and the patient has a history of squamous cell carcinoma. A punch biopsy was performed to obtain a sample for further analysis. While the procedure itself is relatively minor, the stakes are moderately high because the biopsy could determine whether the lesion is cancerous, which would impact the patient's treatment plan and overall prognosis. The potential for a significant diagnosis like cancer justifies a higher stakes rating.


Medical Specialty: Surgery
Sample Name: Pulmonary Valve Stenosis

HISTORY: , The patient is a 19-year-old boy with a membranous pulmonary atresia, underwent initial repair 12/04/1987 consisting of pulmonary valvotomy and placement of 4 mm Gore-Tex shunt between the ascending aorta and pulmonary artery with a snare.  This was complicated by shunt thrombosis __________ utilizing a 10-mm balloon.  Resulting in significant hypoxic brain injury where he has been left with static encephalopathy and cerebral palsy.  On 04/07/1988, he underwent heart catheterization and balloon pulmonary valvuloplasty utilizing a 10-mm balloon.  He has been followed conservatively since that time.  A recent echocardiogram demonstrated possibly a significant right ventricle outflow tract obstruction with tricuspid valve regurgitation velocity predicting a right ventricular systolic pressure in excess of 180 mmHg.  Right coronary artery to pulmonary artery fistula was also appreciated.  The patient underwent cardiac catheterization to assess hemodynamics associated with his current state of repair.,PROCEDURE:,  The patient was placed under general endotracheal anesthesia breathing on 30% oxygen throughout the case.  Cardiac catheterization was performed as outlined in the attached continuation sheets.  Vascular entry was by percutaneous technique, and the patient was heparinized.  Monitoring during the procedure included continuous surface ECG, continuous pulse oximetry, and cycled cuff blood pressures, in addition to intravascular pressures.,Using a 7-French sheath, a 6-French wedge catheter was inserted.  The right femoral vein advanced through the right heart structures out to the branch pulmonary arteries.  This catheter was then exchanged over wire for a 5-French marker pigtail catheter, which was directed into the main pulmonary artery.,Using a 5-French sheath, a 5-French pigtail catheter was inserted in the right femoral artery and advanced retrograde to the descending aorta, ascending aorta, and left ventricle.  This catheter was then exchanged for a Judkins right coronary catheter for selective cannulation of the right coronary artery.,Flows were calculated by the Fick technique using a measured assumed oxygen consumption and contents derived from Radiometer Hemoximeter saturations and hemoglobin capacity.,Cineangiograms were obtained with injection of the main pulmonary artery and right coronary artery.,After angiography, two normal-appearing renal collecting systems were visualized.  The catheters and sheaths were removed and topical pressure applied for hemostasis.  The patient was returned to the recovery room in satisfactory condition.  There were no complications.,DISCUSSION:,  Oxygen consumption was assumed to be normal.  Mixed venous saturation was normal with no evidence of intracardiac shunt.  Left-sided heart was fully saturated.  Phasic right atrial pressures were normal with an A-wave similar to the normal right ventricular end-diastolic pressure.  Right ventricular systolic pressure was mildly elevated at 45% systemic level.  There was a 25 mmHg peak systolic gradient across the outflow tract to the main branch pulmonary arteries.  Phasic branch pulmonary artery pressures were normal.  Right-to-left pulmonary artery capillary wedge pressures were normal with an A-wave similar to the normal left ventricular end-diastolic pressure of 12 mmHg.  Left ventricular systolic pressure was systemic with no outflow obstruction to the ascending aorta.  Phasic ascending and descending pressures were similar and normal.  The calculated systemic and pulmonary flows were equal and normal.  Vascular resistances were normal.  Angiogram with contrast injection in the main pulmonary artery showed catheter induced pulmonary insufficiency.  The right ventricle appeared mildly hypoplastic with a good contractility and mild tricuspid valve regurgitation.  There is dynamic narrowing of the infundibulum with hypoplastic pulmonary annulus.  The pulmonary valve appeared to be thin and moved well.  The median branch pulmonary arteries were of good size with normal distal arborization.  Angiogram with contrast injection in the right coronary artery showed a non-dominant coronary with a small fistula arising from the proximal right coronary artery coursing over the infundibulum and entering the left facing sinus of the main pulmonary artery.,INITIAL DIAGNOSES:,1.  Membranous pulmonary atresia.,2.  Atrial septal defect.,3.  Right coronary artery to pulmonary artery fistula.,SURGERIES (INTERVENTIONS):  ,1.  Pulmonary valvotomy surgical.,2.  Aortopulmonary artery central shunt.,3.  Balloon pulmonary valvuloplasty.,CURRENT DIAGNOSES:  ,1.  Pulmonary valve stenosis supplemented to hypoplastic pulmonary annulus.,2.  Mild right ventricle outflow tract obstruction due to supple pulmonic narrowing.,3.  Small right coronary artery to main pulmonary fistula.,4.  Static encephalopathy.,5.  Cerebral palsy.,MANAGEMENT: , The case to be discussed with combined Cardiology/Cardiothoracic Surgery case conference.  Given the mild degree of outflow tract obstruction in this sedentary patient, aggressive intervention is not indicated.  Conservative outpatient management is to be recommended.  Further patient care will be directed by Dr. X.
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DESCRIPTION: Pulmonary valve stenosis, supple pulmonic narrowing, and static encephalopathy

surgery, membranous pulmonary atresia, atrial septal defect, pulmonary artery fistula, pulmonary valvotomy, central shunt, pulmonary valvuloplasty, static encephalopathy, cerebral palsy, hypoplastic pulmonary annulus, pulmonary valve stenosis, outflow tract obstruction, ventricular systolic pressure, branch pulmonary arteries, systolic pressure, pulmonary arteries, pulmonary valve, branch pulmonary, coronary artery, catheterization, artery, pulmonary, pressures, coronary,

This case involves a 19-year-old patient with a history of complex congenital heart disease, including membranous pulmonary atresia and associated surgical interventions. The patient has experienced significant complications, such as hypoxic brain injury leading to static encephalopathy and cerebral palsy. The current situation details a cardiac catheterization procedure to assess hemodynamics related to the patient's past surgical repairs, finding mild obstructions and other manageable conditions. While the patient's condition is serious given the history of significant health challenges and the complexity of the heart issues, the current findings suggest that there isn't an immediate life-threatening situation, and conservative management is recommended. The stakes are significant due to the potential for serious complications, but they are not of the highest level since the current condition is being managed conservatively.


Medical Specialty: Surgery
Sample Name: Punch Biopsy - 1

PROCEDURE:,  Punch biopsy of right upper chest skin lesion.,ESTIMATED BLOOD LOSS:,  Minimal.,FLUIDS: , Minimal.,COMPLICATIONS:,  None.,PROCEDURE:,  The area around the lesion was anesthetized after she gave consent for her procedure.  Punch biopsy including some portion of lesion and normal tissue was performed.  Hemostasis was completed with pressure holding.  The biopsy site was approximated with non-dissolvable suture.  The area was hemostatic.  All counts were correct and there were no complications.  The patient tolerated the procedure well.  She will see us back in approximately five days.,
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DESCRIPTION: Punch biopsy of right upper chest skin lesion.

The described procedure is a punch biopsy, which is a minor and routine procedure generally associated with low risk. Minimal blood loss, minimal fluid involvement, absence of complications, and the patient tolerating the procedure well further indicate that it is not high-stakes. The follow-up arranged in five days also suggests routine care rather than urgent attention.


Medical Specialty: Surgery
Sample Name: Radioactive Plaque - Insertion

PREOPERATIVE DIAGNOSIS:,  Macular edema, right eye.,POSTOPERATIVE DIAGNOSIS:  ,Macular edema, right eye.,TITLE OF OPERATION: , Insertion of radioactive plaque, right eye with lateral canthotomy.,OPERATIVE PROCEDURE IN DETAIL:  ,The patient was prepped and draped in the usual manner for a local eye procedure.  Initially, a 5 cc retrobulbar injection of 2% Xylocaine was done.  Then, a lid speculum was inserted and the conjunctiva was incised 4 mm posterior to the limbus.  A 2-0 silk traction suture was placed around the insertion of the lateral rectus muscle and, with gentle traction, the temporal one-half of the globe was exposed.  The plaque was positioned on the scleral surface immediately behind the macula and secured with two sutures of 5-0 Dacron.  The placement was confirmed with indirect ophthalmoscopy.  Next, the eye was irrigated with Neosporin and the conjunctiva was closed with 6-0 plain catgut.  The intraocular pressure was found to be within normal limits.  An eye patch was applied and the patient was sent to the Recovery Room in good condition.  A lateral canthotomy had been done.
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DESCRIPTION: Macular edema, right eye.  Insertion of radioactive plaque, right eye with lateral canthotomy.  The plaque was positioned on the scleral surface immediately behind the macula and secured with two sutures of 5-0 Dacron.  The placement was confirmed with indirect ophthalmoscopy.

surgery, canthotomy, ophthalmoscopy, radioactive plaque, scleral surface, macular edema, lateral canthotomy, macular

The document describes a detailed surgical procedure involving the insertion of a radioactive plaque for the treatment of macular edema in the right eye. Surgical procedures, particularly those involving delicate structures like the eye, can be considered high-stakes due to the potential for significant impact on a patient's vision and overall quality of life. The use of radioactive material adds another level of complexity and risk, further elevating the stakes of the procedure.


Medical Specialty: Surgery
Sample Name: Port-A-Cath Insertion - 4

PREOPERATIVE DIAGNOSIS: , Ovarian cancer.,POSTOPERATIVE DIAGNOSIS:,  Ovarian cancer.,OPERATION PERFORMED:,  Insertion of a Port-A-Catheter via the left subclavian vein approach under fluoroscopic guidance.,DETAILED OPERATIVE NOTE:,  The patient was placed on the operating table and placed under LMA general anesthesia in preparation for insertion of a Port-A-Catheter.  The chest was prepped and draped in the routine fashion for insertion of a Port-A-Catheter.  The left subclavian vein was punctured with a single stick and a guidewire threaded through the needle into the superior vena cava under fluoroscopic guidance.  The needle was removed.  An incision was made over the guidewire for entrance of the dilator with sheath.  A second counter incision was made transversally on the chest wall about an inch and half below the puncture site with a #15 blade.  Hemostasis was effective to electrocautery, and a pocket was fashioned subcutaneously for positioning of the reservoir.  The Port-A-Catheter reservoir tubing was attached to the reservoir in the routine fashion.  The reservoir was placed in the pocket and sutured to the anterior chest wall muscle with three interrupted 4-0 Prolene sutures for stability.  Next, a catheter passer was passed from the pocket exiting through the skin at the puncture site, previously placed for the guidewire, and the Port-A-Catheter was pulled from the reservoir exiting on the skin.  It was placed on the chest, measured, and cut to the appropriate length.  This having been done, the dilator with sheath attached was passed over the guidewire into the superior vena cava under fluoroscopic guidance.  The guidewire and dilator were removed, and the Port-A-Catheter was threaded through the sheath into the superior vena cava, and the sheath removed under fluoroscopic guidance.  Fluoroscopy revealed the Port-A-Catheter to be in excellent position.  The Port-A-Catheter was accessed with a butterfly 90-degree needle percutaneously that drew blood well and flushed easily.  It was flushed with heparinized saline connected in cath.  This having been done, the puncture site was closed with a circumferential subcutaneous 3-0 Vicryl suture, and the skin was closed with a percutaneous circumferential subcuticular suture.  This having been done, attention was applied to the reservoir incision.  It was closed with two layers of continuous 3-0 Vicryl suture, and the skin was closed with a continuous 3-0 Monocryl subcuticular stitch.  A dry sterile dressing was applied, and the patient having tolerated the procedure was transferred to the recovery room for postoperative care.
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DESCRIPTION: Insertion of a Port-A-Catheter via the left subclavian vein approach under fluoroscopic guidance in a patient with ovarian cancer.

surgery, ovarian cancer, insertion, port-a-catheter, circumferential, counter incision, fluoroscopic, fluoroscopic guidance, guidewire, subclavian, superior vena cava, port a catheter, port, catheter, subcutaneously, vein

The insertion of a Port-A-Cath is a common surgical procedure, often performed for patients requiring long-term intravenous access, such as chemotherapy for ovarian cancer. While the procedure itself is routine for surgeons, it involves risks like infection, bleeding, or complications from anesthesia. The stakes are moderate because while it supports critical cancer treatment, the operation is straightforward and usually performed on stable patients.


Medical Specialty: Surgery
Sample Name: Port-A-Cath Insertion - 3

TITLE OF PROCEDURE: , Insertion of Port-A-Cath via left subclavian vein using fluoroscopy.,PREOPERATIVE DIAGNOSIS:  ,Metastatic renal cell carcinoma.,POSTOPERATIVE DIAGNOSIS: , Metastatic renal cell carcinoma.,PROCEDURE IN DETAIL:,  This is a 49-year-old gentleman was referred by Dr. A.  The patient underwent a left nephrectomy for renal cell carcinoma in 1999 in Philadelphia.  He has developed recurrence with metastases to the lung and to bone.,The patient is on dialysis via a right internal jugular PermCath that was placed elsewhere.,In the operating room under monitored anesthesia care with intravenous sedation, the patient was prepped and draped suitably.  Lidocaine 1% with epinephrine was used for local anesthesia and the left subclavian vein was punctured at the first pass without difficulty.  A J-wire was guided into place under fluoroscopic control.  A 7.2-French vortex titanium Port-A-Cath was now anchored in the subcutaneous pocket made just below using 3-0 Prolene.  The attached catheter tunneled, cut to the appropriate length and placed through the sheath that was then peeled away.  Fluoroscopy showed good catheter disposition in the superior vena cava.  The catheter was accessed with a butterfly Huber needle, blood was aspirated easily and the system was then flushed using heparinized saline.  The pocket was irrigated using antibiotic saline and closed with absorbable suture.  The port was left accessed with the butterfly needle after dressings were applied and the patient is to report to Dr. A's office later today for the commencement of chemotherapy.  There were no complications.
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DESCRIPTION: Insertion of Port-A-Cath via left subclavian vein using fluoroscopy in a patient with renal cell carcinoma.

surgery, port-a-cath, french vortex, huber, metastatic, permcath, butterfly needle, catheter, fluoroscopy, jugular, nephrectomy, renal cell carcinoma, subclavian vein, vena cava, port a cath, cell carcinoma, insertion, subclavian, carcinoma, port

The situation involves the insertion of a Port-A-Cath for a patient with metastatic renal cell carcinoma. While this procedure is common in oncology practice, it is still invasive and carries inherent risks, such as infection or bleeding. It is important for ongoing cancer treatment, which means complications could delay critical therapies like chemotherapy. The stakes are therefore higher than routine non-invasive procedures, given the need to ensure the procedure is executed correctly to prevent delays in cancer treatment, but it doesn't reach the level of life-threatening emergency surgery. Hence, it should be rated relatively high on the scale.


Medical Specialty: Surgery
Sample Name: Pinning - Ulna

PREOPERATIVE DIAGNOSIS:,  Right both bone forearm refracture.,POSTOPERATIVE DIAGNOSIS: , Right both bone forearm refracture.,PROCEDURE:,  Closed reduction and pinning of the right ulna with placement of a long-arm cast.,ANESTHESIA: , Surgery performed under general anesthesia.  Local anesthetic was 10 mL of 0.25% Marcaine plain.,COMPLICATIONS: , No intraoperative complications.,DRAINS: , None.,SPECIMENS: , None.,HARDWARE:  ,Hardware was 0.79 K-wire.,HISTORY AND PHYSICAL: , The patient is a 5-year-old male who sustained refracture of his right forearm on 12/05/2007.  The patient was seen in the emergency room.  The patient had a complete fracture of both bones with shortening bayonet apposition.  Treatment options were offered to the family including casting versus closed reduction and pinning.  The parents opted for the latter.  Risks and benefits of surgery were discussed.  Risks of surgery included risk of anesthesia, infection, bleeding, changes in sensation and motion of the extremity, hardware failure, and need for later hardware removal, cast tightness.  All questions were answered, and the parents agreed to the above plan.,PROCEDURE IN DETAIL: , The patient was taken to the operating room and placed supine on the operating room table.  General anesthesia was then administered.  The patient received Ancef preoperatively.  The right upper extremity was then prepped and draped in standard surgical fashion.  A small incision was made at the tip of the olecranon.  Initially, a 1.11 guidewire was placed, but this was noted to be too wide for this canal.  This was changed for a 0.79 K-wire.  This was driven up to the fracture site.  The fracture was manually reduced and then the K-wire passed through the distal segment.  This demonstrated adequate fixation and reduction of both bones.  The pin was then cut short.  The fracture site and pin site was infiltrated with 0.25% Marcaine.  The incision was closed using 4-0 Monocryl.  The wounds were cleaned and dried.  Dressed with Xeroform, 4 x 4.  The patient was then placed in a well-moulded long-arm cast.  He tolerated the procedure well.  He was subsequently taken to Recovery in stable condition.,POSTOPERATIVE PLAN: , The patient will be maintain current pin, and long-arm cast for 4 weeks at which time he will return for cast removal.  X-rays of the right forearm will be taken.  The patient may need additional mobilization time.  Once the fracture has healed, we will take the pin out, usually at the earliest 3 to 4 months.  Intraoperative findings were relayed to the parents.  All questions were answered.
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DESCRIPTION: Closed reduction and pinning of the right ulna with placement of a long-arm cast.

surgery, closed reduction, pinning, forearm refracture, fracture site, arm cast,

The surgical procedure described involves a closed reduction and pinning of a refractured forearm in a 5-year-old patient. The stakes are significant due to the patient's young age, the involvement of general anesthesia, and the need for surgical intervention to ensure proper healing and function of the arm. However, the procedure is commonly performed without intraoperative complications and followed the standard protocol with informed consent and risk discussion. Therefore, while not life-threatening, the situation involves some degree of complexity and risk associated with pediatric surgery and anesthesia.


Medical Specialty: Surgery
Sample Name: Pilonidal Cyst Excision

PREOPERATIVE DIAGNOSIS: , Pilonidal cyst with abscess formation.,POSTOPERATIVE DIAGNOSIS:,  Pilonidal cyst with abscess formation.,OPERATION: , Excision of infected pilonidal cyst.,PROCEDURE: , After obtaining informed consent, the patient underwent a spinal anesthetic and was placed in the prone position in the operating room.  A time-out process was followed.  Antibiotics were given and then the patient was prepped and draped in the usual fashion.  It appeared to me that the abscess had drained somewhat during the night, as it was much smaller than I was anticipating.  An elliptical excision of all infected tissues down to the coccyx was performed.  Hemostasis was achieved with a cautery.  The wound was irrigated with normal saline and it was packed open with iodoform gauze and an absorptive dressing.,The patient was sent to recovery room in satisfactory condition.  Estimated blood loss was minimal.  The patient tolerated the procedure well.
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DESCRIPTION: Pilonidal cyst with abscess formation.  Excision of infected pilonidal cyst.

surgery, hemostasis, excision, pilonidal cyst, cyst, abscess, infected,

The procedure described is a surgical intervention for a pilonidal cyst with abscess formation, which is a relatively routine and low-risk operation in the field of surgery. The case details suggest minimal complications and an uncomplicated recovery. While surgery inherently carries some stakes, the description indicates it was straightforward with minimal blood loss and the patient tolerated the procedure well. Therefore, it is not considered high-stakes compared to more invasive or complex surgeries.


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Medical Specialty: Surgery
Sample Name: Pinning - Hip

PREOPERATIVE DIAGNOSIS: , Right acute on chronic slipped capital femoral epiphysis.,POSTOPERATIVE DIAGNOSIS: , Right acute on chronic slipped capital femoral epiphysis.,PROCEDURE: , Revision and in situ pinning of the right hip.,ANESTHESIA: , Surgery performed under general anesthesia.,COMPLICATIONS:  ,There were no intraoperative complications.,DRAINS: , None.,SPECIMENS: , None.,LOCAL:  ,10 mL of 0.50% Marcaine local anesthetic.,HISTORY AND PHYSICAL: , The patient is a 13-year-old girl who presented in November with an acute on chronic right slipped capital femoral epiphysis.  She underwent in situ pinning.  The patient on followup; however, noted to have intraarticular protrusion of her screw.  This was not noted intraoperatively on previous fluoroscopic views.  Given this finding, I explained to the father and especially the mother that this can cause further joint damage and that the screw would need to be exchanged for a shorter one.  Risks and benefits of surgery were discussed.  Risks of surgery include risk of anesthesia, infection, bleeding, changes in sensation and motion of the extremity, failure to remove the screw, possible continued joint stiffness or damage.  All questions were answered and parents agreed to above plan.,PROCEDURE IN DETAIL: , The patient was taken to the operating room and placed supine on the operating table.  General anesthesia was then administered.  The patient received Ancef preoperatively.  A small bump was placed underneath her right buttock.  The right upper thigh was then prepped and draped in standard surgical fashion.  The upper aspect of the incision was reincised.  The dissection was carried down to the crew, which was easily found.  A guidewire was placed inside the screw with subsequent removal of the previous screw.  The previous screw measured 65 mm.  A 60 mm screw was then placed under direct visualization with fluoroscopy.  The hip was taken through full range of motion to check on the length of the screw, which demonstrated no intraarticular protrusion.  The guidewire was removed.  The wound was then irrigated and closed using 2-0 Vicryl in the fascial layer as well as the subcutaneous fat.  The skin was closed with 4-0 Monocryl.  The wound was cleaned and dried, dressed with Steri-Strips, Xeroform, 4 x 4s, and tape.  The area was infiltrated with total 10 mL of 0.5% Marcaine local anesthetic.,POSTOPERATIVE PLAN: , The patient will be discharged on the day of surgery.  She should continue toe touch weightbearing on her leg.  The wound may be wet in approximately 5 days.  The patient should follow up in clinic in about 10 days.  The patient is given Vicodin for pain.  Intraoperative findings were relayed to the mother.
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DESCRIPTION: Revision and in situ pinning of the right hip.

surgery, guidewire, capital femoral epiphysis, intraarticular protrusion, femoral epiphysis, pinning, screw,

The surgery being described involves revision and pinning for a condition known as slipped capital femoral epiphysis, which is a serious condition requiring surgical intervention to prevent further joint damage. Although the situation does not involve life-threatening complications, the procedure is critical in avoiding long-term mobility issues and joint damage for the patient. The process appears routine for a surgical team specialized in orthopedics, with noted standard risks and no current complications, but it is still crucial for the patient's physical health and future mobility.


Medical Specialty: Surgery
Sample Name: Phenol Neurolysis & Botulinum Toxin Injection - 1

PROCEDURES PERFORMED:,  Phenol neurolysis left musculocutaneous nerve and bilateral obturator nerves.  Botulinum toxin injection left pectoralis major, left wrist flexors, and bilateral knee extensors.,PROCEDURE CODES: , 64640 times three, 64614 times four, 95873 times four.,PREOPERATIVE DIAGNOSIS: , Spastic quadriparesis secondary to traumatic brain injury, 907.0.,POSTOPERATIVE DIAGNOSIS:,  Spastic quadriparesis secondary to traumatic brain injury, 907.0.,ANESTHESIA:,  MAC.,COMPLICATIONS: , None.,DESCRIPTION OF TECHNIQUE: , Informed consent was obtained from the patient's brother.  The patient was brought to the minor procedure area and sedated per their protocol.  The patient was positioned lying supine.  Skin overlying all areas injected was prepped with chlorhexidine.  The obturator nerves were identified lateral to the adductor longus tendon origin and below the femoral pulse using active EMG stimulation.  Approximately 7 mL was injected on the right side and 5 mL on the left side.  At all sites of phenol injections in this area injections were done at the site of maximum hip adduction contraction with least amount of stimulus.  Negative drawback for blood was done prior to each injection of phenol.  The musculocutaneous nerve was identified in the left upper extremity above the brachial pulse using active EMG stimulation.  Approximately 5 mL of 5% phenol was injected in this location.  Injections in this area were done at the site of maximum elbow flexion contraction with least amount of stimulus.  Negative drawback for blood was done prior to each injection of phenol.,Muscles injected with botulinum toxin were identified using active EMG stimulation.  Approximately 150 units was injected in the knee extensors bilaterally, 100 units in the left pectoralis major, and 50 units in the left wrist flexors.  Total amount of botulinum toxin injected was 450 units diluted 25 units to 1 mL.  The patient tolerated the procedure well and no complications were encountered.
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DESCRIPTION: Phenol neurolysis left musculocutaneous nerve and bilateral obturator nerves.  Botulinum toxin injection left pectoralis major, left wrist flexors, and bilateral knee extensors.

surgery, spastic quadriparesis, emg stimulation, emg, botulinum toxin injection, traumatic brain, brain injury, phenol neurolysis, toxin injection, musculocutaneous nerve, obturator nerves, pectoralis major, wrist flexors, knee extensors, active emg, botulinum toxin, toxin, injection, stimulus, neurolysis, musculocutaneous, extensors, botulinum, phenol

The procedure described involves nerve injections with phenol neurolysis and botulinum toxin injections, typically performed for managing spasticity in patients with conditions like spastic quadriparesis due to traumatic brain injury. These procedures require precision and careful monitoring to avoid complications, though they are generally routine for experienced practitioners and were performed without complications in this instance. While these are not life-threatening surgeries, they hold moderate stakes due to the specialized nature of the procedures and the potential impact on the patient's quality of life.


Medical Specialty: Surgery
Sample Name: Phenol Neurolysis & Botulinum Toxin Injection - 2

PROCEDURES PERFORMED: , Phenol neurolysis right obturator nerve, botulinum toxin injection right rectus femoris and vastus medialis intermedius and right pectoralis major muscles.,PROCEDURE CODES: , 64640 times one, 64614 times two, 95873 times two.,PREOPERATIVE DIAGNOSIS: , Spastic right hemiparetic cerebral palsy, 343.1.,POSTOPERATIVE DIAGNOSIS:,  Spastic right hemiparetic cerebral palsy, 343.1.,ANESTHESIA:,  MAC.,COMPLICATIONS: , None.,DESCRIPTION OF TECHNIQUE: , Informed consent was obtained from the patient.  She was brought to the minor procedure area and sedated per their protocol.  The patient was positioned lying supine.  Skin overlying all areas injected was prepped with chlorhexidine.  The right obturator nerve was identified using active EMG stimulation lateral to the adductor longus tendon origin and below the femoral pulse.  Approximately 6 mL of 5% phenol was injected in this location.  At all sites of phenol injections, injections were done at the site of maximum hip adduction contraction with least amount of stimulus.  Negative drawback for blood was done prior to each injection of phenol.,Muscles injected with botulinum toxin were identified with active EMG stimulation.  Approximately 100 units was injected in the right pectoralis major and 100 units in the right rectus femoris and vastus intermedius muscles.  Total amount of botulinum toxin injected was 200 units diluted 25 units to 1 mL.  The patient tolerated the procedure well and no complications were encountered.
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DESCRIPTION: Phenol neurolysis right obturator nerve, botulinum toxin injection right rectus femoris and vastus medialis intermedius and right pectoralis major muscles.

surgery, femoris and vastus medialis, intermedius and right pectoralis, rectus femoris and vastus, vastus medialis intermedius, botulinum toxin injection, medialis intermedius, major muscles, cerebral palsy, active emg, emg stimulation, phenol neurolysis, toxin injection, obturator nerve, rectus femoris, pectoralis major, botulinum toxin, pectoralis, botulinum, phenol, injection, toxin

The procedure involves the use of phenol neurolysis and botulinum toxin injections, which require precision, especially considering the patient's condition of spastic right hemiparetic cerebral palsy. The use of anesthesia (MAC) and the need to ensure no complications arises elevate its stakes. However, it is described as having been performed smoothly with no complications. Medical procedures typically carry inherent risks, but this is not an exceptionally high-risk surgery like cardiac or neurological surgeries. Therefore, it's a moderate-stakes situation due to its complexity and potential impact on the patient's quality of life.


Medical Specialty: Surgery
Sample Name: Phacoemulsification of Cataract - 1

PREOPERATIVE DIAGNOSES:,1.  Senile nuclear cataract, left eye.,2.  Senile cortical cataract, left eye., ,POSTOPERATIVE DIAGNOSES:,1.  Senile nuclear cataract, left eye.,2.  Senile cortical cataract, left eye., ,PROCEDURES: , Phacoemulsification of cataract, extraocular lens implant in left eye., ,LENS IMPLANT USED:,  Alcon, model SN60WF, power of 22.5 diopters., ,PHACOEMULSIFICATION TIME:,  1 minute 41 seconds at 44.4% power., ,INDICATIONS FOR PROCEDURE: , This patient has a visually significant cataract in the affected eye with the best corrected visual acuity under moderate glare conditions worse than 20/40.  The patient complains of difficulties with glare in performing activities of daily living.,INFORMED CONSENT:,  The risks, benefits and alternatives of the procedure were discussed with the patient in the office prior to scheduling surgery.  All questions from the patient were answered after the surgical procedure was explained in detail.  The risks of the procedure as explained to the patient include, but are not limited to, pain, infection, bleeding, loss of vision, retinal detachment, need for further surgery, loss of lens nucleus, double vision, etc.  Alternative of the procedure is to do nothing or seek a second opinion.  Informed consent for this procedure was obtained from the patient.,OPERATIVE TECHNIQUE: , The patient was brought to the holding area.  Previously, an intravenous infusion was begun at a keep vein open rate.  After adequate sedation by the anesthesia department (under monitored anesthesia care conditions), a peribulbar and retrobulbar block was given around the operative eye.  A total of 10 mL mixture with a 70/30 mixture of 2% Xylocaine without epinephrine and 0.75% bupivacaine without epinephrine.  An adequate amount of anesthetic was infused around the eye without giving excessive tension to the eye or excessive chemosis to the periorbital area.  Manual pressure and a Honan balloon were placed over the eye for approximately 2 minutes after injection and adequate akinesia and anesthesia was noted.  Vital sign monitors were detached from the patient.  The patient was moved to the operative suite and the same monitors were reattached.  The periocular area was cleansed, dried, prepped and draped in the usual sterile manner for ocular surgery.  The speculum was set into place and the operative microscope was brought over the eye.  The eye was examined.  Adequate mydriasis was observed and a visually significant cataract was noted on the visual axis.,A temporal clear corneal incision was begun using a crescent blade with an initial groove incision made partial thickness through the temporal clear cornea.  Then a pocket incision was created without entering the anterior chamber of the eye.  Two peripheral paracentesis ports were created on each side of the initial incision site.  Viscoelastic was used to deepen the anterior chamber of the eye.  A 2.65 mm keratome was then used to complete the corneal valve incision.  A cystitome was bent and created using a tuberculin syringe needle.  It was placed in the anterior chamber of the eye.  A continuous curvilinear capsulorrhexis was begun.  It was completed using O'Gawa Utrata forceps.  A balanced salt solution on the irrigating cannula was placed through the paracentesis port of the eye to affect hydrodissection and hydrodelineation of the lens nucleus.  The lens nucleus was noted to be freely mobile in the bag.,The phacoemulsification tip was placed into the anterior chamber of the eye.  The lens nucleus was phacoemulsified and aspirated in a divide-and-conquer technique.  All remaining cortical elements were removed from the eye using irrigation and aspiration using a bimanual technique through the paracentesis ports.  The posterior capsule remained intact throughout the entire procedure.  Provisc was used to deepen the anterior chamber of the eye.  A crescent blade was used to expand the internal aspect of the wound.  The lens was taken from its container and inspected.  No defects were found.  The lens power selected was compared with the surgery worksheet from Dr. X's office.  The lens was placed in an inserter under Provisc.  It was placed through the wound, into the capsular bag and extruded gently from the inserter.  It was noted to be adequately centered in the capsular bag using a Sinskey hook.  The remaining viscoelastic was removed from the eye with irrigation an aspiration through the paracentesis side ports using a bimanual technique.  The eye was noted to be inflated without overinflation.  The wounds were tested for leaks, none were found.  Five drops dilute Betadine solution was placed over the eye.  The eye was irrigated.  The speculum was removed.  The drapes were removed.  The periocular area was cleaned and dried.  Maxitrol ophthalmic ointment was placed into the interpalpebral space.  A semi-pressure patch and shield was placed over the eye.  The patient was taken to the floor in stable and satisfactory condition, was given detailed written instructions and asked to follow up with Dr. X tomorrow morning in the office.
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DESCRIPTION: Phacoemulsification of cataract, extraocular lens implant in left eye.

surgery, senile nuclear cataract, senile, phacoemulsification, phacoemulsification of cataract, lens implant, lens nucleus, anterior chamber, lens, alcon, eye, cataract,

The procedure described is a phacoemulsification surgery, which is a common and often routine procedure for cataract removal and lens implantation. While there are inherent risks associated with any surgical procedure, cataract surgeries generally have a high success rate and are performed frequently worldwide. The informed consent outlines potential risks such as pain, infection, or loss of vision, but these are standard risks explained to the patient. The report indicates that the operation went smoothly without complications, and the patient's condition was stable afterward. Although every surgical procedure involves some level of risk, this particular procedure does not appear to carry exceptionally high stakes compared to other surgical interventions.


Medical Specialty: Surgery
Sample Name: Phacoemulsification & Lens Implantation - 6

PROCEDURE: , Phacoemulsification with posterior chamber intraocular lens insertion.,INTRAOCULAR LENS: , Allergan Medical Optics model S140MB XXX diopter chamber lens.,PHACO TIME:,  Not known.,ANESTHESIA: , Retrobulbar block with local minimal anesthesia care.,COMPLICATIONS:  ,None.,ESTIMATED BLOOD LOSS:,  None.,DESCRIPTION OF PROCEDURE: , While the patient was in the holding area, the operative eye was dilated with four sets of drops.  The drops consisted of Cyclogyl 1%, Acular, and Neo-Synephrine 2.5 %.  Additionally, a peripheral IV was established by the anesthesia team.  Once the eye was dilated, the patient was wheeled to the operating suite.,Inside the operating suite, central monitoring lines were established.  Through the peripheral IV, the patient received intravenous sedation consisting of Propofol and once somnolent from this, retrobulbar block was administered consisting of 2 cc's of 2% Xylocaine  plain with 150 units of Wydase.  The block was administered in a retrobulbar fashion using an Atkinson needle and a good block was obtained.  Digital pressure was applied for approximately five minutes.,The patient was then prepped and draped in the usual sterile fashion for ophthalmological surgery.  A Betadine prep was carried out of the face, lids, and eye.  During the draping process, care was taken to isolate the lashes.  A wire lid speculum was inserted to maintain patency of the lids.  With benefit of the operating microscope, a diamond blade was used to place a groove temporally.  A paracentesis wound was also placed temporally using the same blade.  Viscoelastic was then instilled into the anterior chamber through the paracentesis site and a 2.8 mm. diamond keratome was used to enter the anterior chamber through the previously placed groove.  The cystotome was then inserted into the eye and circular capsulorhexis was performed without difficulty.  The capsular remnant was withdrawn from the eye using long angled McPherson forceps.  Balanced salt solution with a blunt cannula was then inserted into the eye and hydrodissection was performed.  The lens was noted to rotate freely within the capsular bag.  The phaco instrument was then inserted into the eye using the Kelman tip.  The lens nucleus was grooved and broken into two halves.  One of the halves was in turn broken into quarters.  Each of the quarters was removed from the eye using the memory 2 settings and phacoemulsification.  Attention was then turned toward the remaining half of the nucleus and this, in turn, was removed as well, with the splitting maneuver.  Once the nucleus had been removed from the eye, the irrigating and aspirating tip was inserted and the cortical material was stripped out in sections.  Once the cortical material had been completely removed, a diamond dusted cannula was inserted into the eye and the posterior capsule was polished.  Viscoelastic was again instilled into the capsular bag as well as the anterior chamber.  The wound was enlarged slightly using the diamond keratome.  The above described intraocular lens was folded outside the eye using a mustache fold and inserted using folding forceps.  Once inside the eye, the lens was unfolded into the capsular bag in a single maneuver.  It was noted to be centered nicely.  The viscoelastic was then withdrawn from the eye using the irrigating and aspirating tip of the phaco machine.,Next, Miostat was instilled into the operative eye and the wound was checked for water tightness.  It was found to be such.  After removing the drapes and speculum, TobraDex drops were instilled into the operative eye and a gauze patch and Fox protective shield were placed over the eye.,The patient tolerated the procedure extremely well and was taken to the recovery area in good condition.  The patient is scheduled to be seen in follow-up in the office tomorrow, but should any complications arise this evening, the patient is to contact me immediately.
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DESCRIPTION: Phacoemulsification with posterior chamber intraocular lens insertion.

surgery, diopter, intraocular lens insertio, phacoemulsification, posterior chamber, diamond keratome, anterior chamber, capsular bag, intraocular lens, intraocular, allergan, eye, capsular, chamber, lens,

The described procedure is a detailed account of phacoemulsification and lens implantation, a common and routine surgical procedure performed to treat cataracts. Although the surgery involves delicate and precise work, it is considered routine by ophthalmologists and is generally safe with a high success rate in the absence of complications. No complications were reported in this case. Therefore, while the procedure requires skill and care, the stakes are typically not characterized as high compared to more critical or life-threatening surgeries.


Medical Specialty: Surgery
Sample Name: Phacoemulsification & Lens Implantation - 5

PREOPERATIVE DIAGNOSIS:,  Cataract, right eye.,POSTOPERATIVE DIAGNOSIS:,  Cataract, right eye.,OPERATION PERFORMED: , Phacoemulsification with IOL, right eye.,ANESTHESIA:,  Topical with MAC.,COMPLICATIONS,:  None.,ESTIMATED BLOOD LOSS: , None.,PROCEDURE IN DETAIL:  After appropriate consent was obtained, the patient was brought to the operating room and then prepared and draped in the usual sterile fashion per Ophthalmology.  A lid speculum was placed in the right eye after which a supersharp was used to make a stab incision at the 4 o'clock position through which 2% preservative-free Xylocaine was injected followed by Viscoat.  A 2.75-mm keratome then made a stab incision at the 2 o'clock position through which an anterior capsulorrhexis was performed using cystotome and Utrata.  BSS on blunt cannula, hydrodissector, and spun the nucleus after which phacoemulsification divided the nucleus in 3 quadrants each was subsequently cracked and removed through phacoemulsification I&A.  Healon was injected into the posterior capsule and a XXX lens was then placed with a shooter into the posterior capsule and rotated into position with I&A, which then removed all remaining cortex as well as viscoelastic material.  BSS on blunt cannula hydrated all wounds, which were noted to be free of leak and lid speculum was removed.  Under microscope, the anterior chamber being soft and well formed.  Pred Forte, Vigamox, and Iopidine were placed in the eye.  A shield was placed over the eye.  The patient was followed to recovery where he was noted to be in good condition.
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DESCRIPTION: Phacoemulsification with IOL, right eye.  Cataract, right eye.  A lid speculum was placed in the right eye after which a supersharp was used to make a stab incision at the 4 o'clock position through which 2% preservative-free Xylocaine was injected followed by Viscoat.

surgery, lid speculum, lens, iol, viscoat, posterior, capsule, cataract, speculum, incision, phacoemulsification

The context describes a routine cataract surgery using phacoemulsification and lens implantation. Such procedures are common in ophthalmology and typically have low risk, especially considering there were no complications or blood loss mentioned. The presence of a detailed and uneventful procedural report further supports the low-stakes nature of this situation. However, as with any surgery, especially involving the eye, there is still a level of importance and risk, but it is significantly managed and low given the routine nature of the operation.


Medical Specialty: Surgery
Sample Name: Phacoemulsification & Lens Implantation - 4

OPERATION PERFORMED:, Phacoemulsification of cataract and posterior chamber lens implant, right eye., ,ANESTHESIA:, Retrobulbar nerve block, right eye, ,DESCRIPTION OF OPERATION: ,The patient was brought to the operating room where local anesthetic was administered to the right eye followed by a dilute drop of Betadine and a Honan balloon.  Once anesthesia was achieved, the right eye was prepped with Betadine, rinsed with saline, and draped in a sterile fashion.  A lid speculum was placed and 4-0 silk sutures passed under the superior and inferior rectus muscles stabilizing the globe.  A fornix-based conjunctival flap was prepared superiorly from 10 to 12 o'clock and episcleral vessels were cauterized using a wet-field.  A surgical groove was applied with a 69 Beaver blade 1 mm posterior to the limbus in a frown configuration in the 10 to 12 o'clock position.  A lamellar dissection was carried anteriorly to clear cornea using a crescent knife.  A stab incision was applied with a Superblade at the 2 o'clock position at the limbus.  The chamber was also entered through the lamellar groove using a 3-mm keratome in a beveled fashion.  Viscoat was injected into the chamber and an anterior capsulorrhexis performed.  Hydrodissection was used to delineate the nucleus and the phacoemulsification tip was inserted into the chamber.  A deep linear groove was dissected through the nucleus vertically and the nucleus was rotated 90 degrees with the assistance of a spatula through the side-port incision.  A second groove was dissected perpendicular to the first and the nucleus was fractured into quadrants.  Each quadrant was emulsified under burst power within the capsular bag.  The epinuclear bowl was manipulated with vacuum, flipped into the iris plane, and emulsified under pulse power.  I&A was used to aspirate cortex from the capsular bag.  A scratcher was used to polish the capsule, and Viscoat was injected inflating the capsular bag and chamber.  The wound was enlarged with a shortcut blade to 5.5 mm.  The intraocular lens was examined, found to be adequate, irrigated with balanced salt, and inserted into the capsular bag.  The lens centralized nicely and Viscoat was removed using the I&A.  Balanced salt was injected through the side-port incision.  The wound was tested, found to be secure, and a single 10-0 nylon suture was applied to the wound with the knot buried within the sclera.  The conjunctiva was pulled over the suture, and Ancef 50 mg and Decadron 4 mg were injected sub-Tenon in the inferonasal and inferotemporal quadrants.  Maxitrol ointment was applied topically followed by an eye pad and shield.  The patient tolerated the procedure and was taken from the operating room in good condition.
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DESCRIPTION: Phacoemulsification of cataract and posterior chamber lens implant, right eye.

surgery, retrobulbar nerve block, posterior chamber lens implant, phacoemulsification of cataract, lens implantation, capsular bag, cataract, phacoemulsification, nucleus, capsular, lens, eye

This operation involves surgery on the eye, specifically a phacoemulsification and lens implantation for cataracts. While cataract surgery is a common and generally safe procedure, it still carries certain risks inherent to surgeries, such as infection, bleeding, or complications leading to vision problems. As it's an eye surgery, outcomes are crucial as they directly affect a patient's sense of sight, which is very important for quality of life. However, it is not considered life-threatening under normal circumstances.


Medical Specialty: Surgery
Sample Name: Phacoemulsification & Lens Implantation - 3

PREOPERATIVE DIAGNOSIS: , Cataract, right eye.,POSTOPERATIVE DIAGNOSIS:,  Cataract, right eye.,PROCEDURE:,  Phacoemulsification with intraocular lens placement, right eye.,ANESTHESIA: , Monitored anesthesia care,ESTIMATED BLOOD LOSS: , None,COMPLICATIONS:,  None,SPECIMENS:,  None,PROCEDURE IN DETAIL: , The patient had previously been examined in the clinic and was found to have a visually significant cataract in the right eye.  The patient had the risks and benefits of surgery discussed.  After discussion, the patient decided to proceed and the consent was signed.,On the day of surgery, the patient was taken from the holding area to the operating suite by the anesthesiologist and monitors were placed.  Following this, the patient was sterilely prepped and draped in the usual fashion.  After this, a lid speculum was placed, preservative-free lidocaine drops were placed, and the SuperSharp blade was used to make an anterior chamber paracentesis.  Preservative-free lidocaine was instilled into the anterior chamber, and then Viscoat was instilled into the eye.,The 3.0 diamond keratome was then used to make a clear corneal temporal incision.  Following this, the cystotome was used to make a continuous tear-type capsulotomy.  After this, BSS was used to hydrodissect and hydrodelineate the lens.  The phacoemulsification unit was used to remove the cataract.  The I&A unit was used to remove the residual cortical material.  Following this, Provisc was used to inflate the bag.  The lens, a model SA60AT of ABCD diopters, serial #1234, was inserted into the bag and rotated into position using the Lester pusher.,After this, the residual Provisc was removed.  Michol was instilled and then the corneal wound was hydrated with BSS, and the wound was found to be watertight.  The lid speculum was removed.  Acular and Vigamox drops were placed.  The patient tolerated the procedure well without complications and will be followed up in the office tomorrow.
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DESCRIPTION: Cataract, right eye.  Phacoemulsification with intraocular lens placement, right eye.

surgery, capsulotomy, diopters, intraocular lens placement, lid speculum, anterior chamber, phacoemulsification, lens, cataract, intraocular

Phacoemulsification with intraocular lens implantation is a common surgical procedure for treating cataracts and is generally considered to be low-risk with a high success rate, particularly without any noted complications or blood loss as described in this case. It is elective surgery, meaning it is not urgent or life-threatening, reducing the stakes. Patients are typically able to see better very soon after the procedure, which contributes to its characterization as a low-stakes surgery. However, as with any surgery, there are always inherent risks, even if minimal.


Medical Specialty: Surgery
Sample Name: Phacoemulsification & Lens Implantation - 2

PROCEDURE PERFORMED: , Phacoemulsification with intraocular lens placement.,ANESTHESIA TYPE:  ,Topical.,COMPLICATIONS: , None.,DESCRIPTION OF PROCEDURE:  ,The patient was brought to the operating room after the eye was dilated with topical Mydriacyl and Neo-Synephrine eye drops.  Topical anesthetic drops were applied to the eye just prior to entering the operating room.  The eye was then prepped with a 5% Betadine solution injected in the usual sterile fashion.  A wire speculum was placed in the eye and then a clear corneal paracentesis site was made inferiorly with a 15-degree blade.  Lidocaine 1% preservative-free, 0.1 cc, was instilled into the anterior chamber through the clear corneal paracentesis site and this was followed with viscoelastic to fill the chamber.  A 2.8-mm keratome was used to create a self-sealing corneal incision temporally and then a bent capsulotomy needle was used to create an anterior capsular flap.  The Utrata forceps were used to complete a continuous tear capsulorrhexis, and hydrodissection and hydrodelineation of the nucleus was performed with BSS on a cannula.  Phacoemulsification in a quartering and cracking technique was used to remove the nucleus, and then the residual cortex was removed with the irrigation and aspiration unit.  Gentle vacuuming of the central posterior capsule was performed with the irrigation and aspiration unit.  The capsular bag was re-expanded with viscoelastic, and then the wound was opened to a 3.4-mm size to accommodate the intraocular lens insertion using an additional keratome blade.,The lens was folded, inserted into the capsular bag and then unfolded.  The trailing haptic was tucked underneath the anterior capsular rim.  The lens was shown to center very well.  The viscoelastic was removed with the irrigation and aspiration unit and one 10-0 nylon suture was placed across the incision after Miochol was injected into the anterior chamber to cause pupillary constriction.  The wound was shown to be watertight.  Therefore, TobraDex ointment was applied to the eye, an eye pad loosely applied, and a Fox shield taped firmly in place over the eye.,The patient tolerated the procedure well and left the operating room in good condition.
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DESCRIPTION: Phacoemulsification with intraocular lens placement.  A wire speculum was placed in the eye and then a clear corneal paracentesis site was made inferiorly with a 15-degree blade.

surgery, keratome, phacoemulsification, cortex, tobradex, intraocular lens, aspiration unit, topical, chamber, viscoelastic, corneal, capsular, lens, intraocular, eye,

Phacoemulsification with intraocular lens placement is typically a common and routine surgical procedure for cataract removal. It has a high success rate and is minimally invasive compared to other types of surgeries. The procedure description indicates that there were no complications and the patient tolerated it well, leaving in good condition. Although every surgical procedure carries some inherent risks, this specific operation is generally not high-risk when compared to other surgeries.