3 Sentence cases Flashcards
Adrenalectomy
Subcostal incision, open lesser sac and mobilize splenic flexure, identify left renal vein and adrenal vein take off and ligate, dissect the rest and ligate vessels
Retract liver and incise peritoneum, work plane between IVC and adrenal to find adrenal vein and ligate, dissect away adrenal
Fundoplication
1 - Upper midline, divide HGL to the R crus – dissect around to the left, take greater omentum(stay 1 cm off!!!!!!) Dissect 4cm of esoph into abdomen
2 - Approx crus over 56F bougie and pull fundo behind to the right and suture together taking esoph and stomach
3 - close
POD1 stuff for nissen
esophagram –> advance to soft for 6 weeks, stop ppi, crush meds
Lumpectomy
- U/s wire loc and incise over area of interest
- Bovie around lump and remove
- Paint and mammo bedside
Sentinel lymph node biopsy
- Axillary incision over point of highest radioactivity
- Dissect through adipose into axillary fat
- Remove blue/hot node and close in layers
Axillary dissection
Mastectomy
Parathyroidectomy(single and bilateral)
- transverse cervical incision 1 cm below the cric cart carried through plastysma with flap creation then dividing straps
- find glands in picture, look for ectopics in carotid sheat, thyroid, retroesoph groove and thymus
- send to path and monitor PTH for 10 min, close
thyroidectomy
- Collar incision carried through the platysma, divide strap muscles
- Medial rotation, preserve PTs, divide middle vein on capsule
- Identify RLN in TEG and ligate infeior thyroid a
- Ligate superior bundle and complete medial rotation taking ismuth, then close
Right adrenalectomy
Right triangular ligament, kocher, IVC to right crus
Ligate vein
Ligasure arteries
Remove
Left adrenalectomy
Mobilize splenic flexure
Ligate arteries and phrenic veins
Remove
CEA
- Incision and dissection: Incision along SCM dissecting through platysma, the SCM is retratced laterally and the jugular vein is identied with ligation of the facial and exposure of carotid above and below bifurcation protecting vagus nerve
- Proximal and distal control in ICE order followed by arteriotomy and plaque removal with elevator. Tag ends and sew in patch after flushing all three branches
- Release in ECI then close in layers
ladds procedure
- Detorse CC and assess viability
- Lyse band between cecum and liver, broaden duoenal mesentery and sb mesentery eestablishing SB in right abdomen and colon in left
- Appy
Roux n y GP
- Mobilize proximal stomach, lesser sac and peritoneal attach to spleen. Staple proximal stomach
- Create Roux limb and JJ 50 cm from ligament of treitz with a 75cm roux
- Staple and sew GJ
Lap Splenectomy
McVay
Inguinal LN dissection
- Isolate LN with gamma probe and look for higher CPM(counts per minute)
2.cut down vertically above fem triangle(between sartorious lateral and add long medial) - send any nodes that are blue or hot(>10%)
Whipple
Distal pancreatectomy
Mastectomy
borders?
Clavicle superiorly
Border of the sternum medially
Superior border of the rectus sheath inferiorly (or the inframammary crease)
Latissimus dorsi laterally
esophagectomy
- Create gastric conduit stapling angle of his to incisura, preserving right gastroepiploic arcade
- Circumfrentially dissect the esophagus until up to left main bronchus
- Create left neck incision, remove specimen, pull conduit through and create hand sewn anastomosis
- Place feeding access NG vs J tube and close
