T14-2B OPERATIVE REPORT, CHOLECYSTECTOMY

question 4

Essay

T14-2B OPERATIVE REPORT, CHOLECYSTECTOMY
Do not assign diagnostic codes. Anesthesia by: MDA and CRNA. Anesthesiologist was medically directing 4 concurrent cases.
INDICATIONS: The patient is a 78-year-old female who presents with an abnormal CCK (cholecystokinin) HIDA (hepatobiliary imino-diacetic acid [imaging test]) scan. She presents today for elective laparoscopic cholecystectomy. She understands the risks of bleeding, infection, possible damage to the biliary system, and possible conversion to open procedure, and she wishes to proceed.
PROCEDURE: The patient was brought to the operating table and placed under general anesthesia. Foley catheter and orogastric tubes were inserted, and she was prepped and draped sterilely. A supraumbilical skin incision was made with a #11 blade, and dissection was carried down through subcutaneous tissues. Bluntly, midline fascia was grasped with a Kocher clamp, and 0 Vicryl sutures were placed on either side of the midline fascia. The Veress needle was then inserted into the abdominal cavity; drop test confirmed placement within the peritoneal space. The abdomen was insufflated with carbon dioxide; a 10-mm (millimeter) trocar port and laparoscope were introduced, showing no damage to the underlying viscera. Under direct vision, three additional trocar ports were placed, one upper midline 10 mm, two right upper quadrant 5 mm. The gallbladder was grasped and was elevated from its fossa. The cystic duct and artery were dissected and doubly clipped proximally and distally, dividing them with the scissors. The gallbladder was then shelled from its fossa using electrocautery and brought up and out of the upper midline incision. The abdomen was irrigated with saline until returns were clear. There was no bleeding from the liver bed. Clips were in with no evidence of bleeding. When we were removing the final port, we could see down in the right groin, and she had small indirect inguinal hernia, which was about 3 mm in size. We removed the remaining trocar port with no evidence of bleeding, closed the supraumbilical and upper midline ports and fascial defects with interrupted 0 Vicryl sutures, and closed the skin at all port sites with subcuticular 4-0 undyed Vicryl. Steri-Strips and sterile bandages were applied.
PATHOLOGY REPORT LATER INDICATED: Benign tissue.
T14-2B:
PHYSICIAN CODE: ___________________
CRNA CODE: ___________________
QUALIFYING CIRCUMSTANCES CODE: __________________

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Definitions:

Green Light

An expression meaning to give approval to proceed with a project or action.

Lever Pushing

A task used in experimental psychology and behavioral neuroscience to study the principles of operant conditioning by training an animal to press a lever to receive a reward.

Red Light

A signal used in traffic lights, indicating a command to stop, or metaphorically, an indication to halt an activity or process.

Primary Reinforcers

Biological necessities that act as rewarding stimuli without prior conditioning, such as food and water.