Surgery for well-differentiated thyroid cancer
Demetrius Pertsemlidis, William B. Inabnet III, Michel Gagner in Endocrine Surgery, 2017
Once adequate hemostasis in confirmed, the use of hemostatic agents is uncommonly required and is based on risk factors. Drains do not prevent hematoma after thyroidectomy, but can facilitate the detection of bleeding, whereas after LND, they can help to identify lymphatic leak. We reserve drain use for LND and for the uncommon thyroidectomy patient with difficult habitus, massive goiter resection, or known coagulopathy. The strap and platysma muscles are closed with absorbable suture. The skin is cosmetically closed with running subcuticular absorbable suture. Steri strips or medical glue is applied as a dressing. Figure 13.4a and b shows the typical immediate postoperative and initial follow-up incision appearance. It is important to communicate in the dictated operative report all essential intraoperative findings [47].
Patient selection, preparation, risks, and informed consent
Debabrata Mukherjee, Eric R. Bates, Marco Roffi, Richard A. Lange, David J. Moliterno, Nadia M. Whitehead in Cardiovascular Catheterization and Intervention, 2017
For patients with prior cardiac catheterization, the approach, equipment, and findings, including a review of the images, should be reviewed whenever feasible. There is no use trying to engage the left coronary artery with a Judkins left 4 catheter when the previous operator was successful with a Judkins left 6, or to rediscover an anomalous coronary artery. For patients with prior coronary bypass surgery, the preoperative native coronary anatomy, operative report, and postoperative angiograms, if performed, should be reviewed. Every effort should be made to review the original operative report rather than rely on a summary of the graft anatomy, which may be misleading. Attention should be paid to the number and types of conduits and any special circumstances, such as use of a free versus in situ left internal mammary graft, use of uncommon conduits such as a gastroepiploic graft, or placement of a saphenous vein graft (SVG) off the descending aorta. When the operative report is unavailable and the proce- dure cannot be delayed, aortography and bilateral mammary injections should be considered to assist in locating grafts.
Sources of Medical Information
Julie Dickinson, Anne Meyer, Karen J. Huff, Deborah A. Wipf, Elizabeth K. Zorn, Kathy G. Ferrell, Lisa Mancuso, Marjorie Berg Pugatch, Joanne Walker, Karen Wilkinson in Legal Nurse Consulting Principles and Practices, 2019
Surgical procedures are performed in an operating suite. Other invasive procedures may take place in the radiology department, endoscopy unit, intensive care unit, or the pre-operative area. The provider who performed the surgery or procedure completes a procedure report, which must be completed within the period mandated by the facility’s policies and procedures. For surgical procedures, the surgeon completes an interim operative report to ensure skilled care in the post-operative period and transition to next level of care (The Joint Commission, 2018b).
International assessment of interobserver reproducibility of flap delineation in head and neck carcinoma
Published in Acta Oncologica, 2022
Arnaud Beddok, Leslie Guzene, Alexandre Coutte, David Thomson, Sue S. Yom, Valentin Calugaru, Eivind Blais, Olivier Gilliot, Séverine Racadot, Yoann Pointreau, June Corry, Kenneth Jensen, Sandro Porceddu, Nazim Khalladi, Vianney Bastit, Audrey Lasne-Cardon, Pierre-Yves Marcy, Florent Carsuzaa, Christophe Nioche, Jean Bourhis, Julia Salleron, Juliette Thariat
The lack of reproducibility for FAMM flap delineation could be due to the complex visualization of the flap on postoperative imaging, including CT [19]. A postoperative MRI could possibly help the radiation oncologist to delineate the FAMM flap, especially the T1 and T2-weighted MR, and the CUBE enhanced fat-suppressed T1-weighted MR. This was however beyond the scope of the current study. It is important to remember that this flap is usually short, harvested in a plane deep to the facial artery by including the overlying part of the buccinator muscle along its length and part of the orbicularis oris in the area of the oral commissure [20]. The FAMM flap is rotated next to its native mucosal cheek area. It does not add any unusual tissue such as bone, thick muscle, or artificial material in the reconstructed area, which may have made it easier to identify on imaging. Therefore, even more than for other flaps, the operative report is necessary to accurately locate the flap site and its components based on their tissue densities, length and thickness after flap harvesting and reshaping. A standardized operative report should include precise information, already listed in the atlas [11].
Parotid gland pleomorphic adenoma re-operations with regard to patient and surgeon satisfaction: what can be improved?
Published in Annals of Medicine, 2023
Ewelina Bartkowiak, Krzysztof Piwowarczyk, Jadzia Tin-Tsen Chou, Hanna Klimza, Małgorzata Wierzbicka
While the re-operative course appears to be independent of previous actions in the operated area, subsequent surgeries nevertheless benefit from accurate imaging of the operated area and the estimated deviation from the typical treatment course [9]. The following pre-operative data can be useful: patient history including the first operative course, concordance with the first operative report (FOpR), and magnetic resonance imaging (MRI), which is the study of choice for rPA [10–12]. Accurate MRI protocols quantify: tumor spread characteristics, the number of nodules, their precise location and size, and the amount of remaining parenchyma [9]. For re-operation, the crucial datum is the contact or distance from the FN trunk and branches [13]. If the nerve was exposed and dissected, it may be very difficult to locate and preserve amongst fibrous tissue [2]. The extent of the procedure (part/whole superficial lobe/deep lobe) is less important because in the event of relapse, a radical resection is attempted with removal of residual parotid parenchyma and structures demonstrating nodular involvement. Nevertheless, this detail can guide the approach to the deep layers as well as the FN main trunk location and depth.
Technical Tips: A Checklist for Responding to Intraoperative Neuromonitoring Changes
Published in The Neurodiagnostic Journal, 2019
Rebecca Rendahl, Lloyd A. Hey
The checklist also provided an unexpected benefit in documentation. In the paper copy of the checklist provided on each IONM machine, the technologist notated all the corrections and modifications that the team used (successfully or not) to improve the neurologic outcome for their documentation in the patient record and in the technologist’s notes for the patient’s chart. Having the information available in one document including further details about the other teams’ actions during monitoring changes, and providing this information to the surgeon at the end of the case, enables the surgeon to be quickly supplied with a comprehensive document of all remediation for the operative report.