Operation:

1. Exploratory left thoracotomy
2. Left total pneumonectomy

Procedure Detail:

This patient was operated on under general endotracheal anesthesia. We used a double lumen tube where we could selectively ventilate both lungs. He was in the lateral decubitus position.

A standard posterior lateral left thoracotomy incision was created and the chest was opened. There was a large diffuse lesion in the left upper lobe periphery. The lesion had previously been biopsied, and we thought we were dealing with a bronchial alveolar cell carcinoma.

I began dissecting on the pulmonary artery to see what kind of fissure had developed, but the inner lobar branches were too dense; that is, there was basically no fissure. I knew if I did a lobectomy, it was really entering the tumor area peripherally.

I therefore went ahead and elected to do a left pneumonectomy since his pulmonary function studies were satisfactory preop. The main pulmonary artery was divided between a vascular staple gun. Dissection was a little tenuous. The artery seemed quite friable, but it held nicely. I then reinforced this with a large Chromic tie. We divided the superior and inferior pulmonary vein and prepared for clamping of the bronchus. This completed the pneumonectomy.

He tolerated the procedure well. He had some hypotension, but he was hypotensive on induction throughout the entire procedure. Blood gases were satisfactory during clamping of the mainstem bronchus, and he seemed to be reacting well. We closed the chest in layers with sutures, approximated clips on the skin.

Case Study 4

0BTL0ZZ Resection, Lung, Left (0BTL)

Rationale: The provider performs a thoracotomy to determine how to proceed. The provider determines that there is a large lesion in the left upper lobe with dense inner lobar branches. Due to the density of the lobar branches with the bronchial alveolar cell carcinoma, the decision is made to remove the lung in its entirety instead of only removing a lobe of the lung. Resection is the root operation utilized when removing an entire body part.

We do not code separately inspection since it was done via the same approach and resulted in a definitive procedure.