Thoracic surgery Insertionof Pacemaker

Insertion of Transvenous Endocardial Pacemaker

Objective

In cases of heart block:

•   Placing of an electrode lead in the endocardium through the cephalic, subclavian, or jugular vein and attaching the lead to a pulse generator.

Position

Supine.

Anesthesia

Local.

Procedure

1.  Cut down is performed to expose the subclavian, cephalic or external jugular vein.

2.  A ventomy, a pacing electrode is inserted and advanced into the right ventricle.

3.  The electrode is attached to an external pacemaker for testing.

4.  An incision is made in the chest wall and deepened down to the fascia, creating a “pocket’ for the pulse generator.

5.  The pulse generator is placed in the pocket.

6.  Both incisions may be irrigated with a antibiotic solution and closed.

Instruments

•   Pacemaker tray 

•   Hemoclip appliers (small and medium) 

•   Basin set 

•   Blades (2) No. 10, (1) No. 15, (1) No. 11 

•   Vessel loops 

•   Local syringe and needle 

•   Antibiotic irrigation and bulb syringe.

Any questions be sent to drmmkapur@gmail.com

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Thoraic Surgery decortication lung procedure instruments

Decortication of the Lung

Objective

In cases of chronic empyema or TB of lung:

•   The stripping of a membrane on the visceral pleura that interferes with respiration.

Position

Lateral.

Anesthesia

General.

Procedure

1.  Affected lung is exposed through a posterolateral incision.

2.  Rib resection may be indicated for adequate exposure.

3.  Fibrous membrane is carefully peeled away from the visceral pleura.

4.  Hemostasis may be difficult.

5.  Chest tubes are inserted.

6.  Wound is closed in layers.

7.  Chest tubes are connected to a sealed drainage unit.

Instruments

•   Major procedures tray 

•   Thoracotomy tray 

•   Vascular procedures tray 

•   Hemoclip appliers, assorted sizes, long handled 

•   Long Pean clamps 

•   Stapling devices 

•   Cushing vein retractors 

•   Basin set 

•   Suction tubing 

•   Blades (3) No. 10, (1) No. 15 

•   Dissectors

•   Asepto syringes (2) 

•   Staples

•   Hemoclips

•   Vessel loops, umbilical tapes 

•   Chest drainage tube(s) 

•   Connector for example, straight or large Y 

•   Sealed drainage unit.

Any questions be sent to drmmkapur@gmail.com

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Thoracic Surgery pneumonectomy

Pneumonectomy

Objective

•   Removal of the lung in cancer 

•   In bronchiectasis.

Position

Lateral.

Anesthesia

General.

Procedure

1.  Affected lung is exposed through a posterolateral thoraco­tomy.

2.  Chest is explored.

3.  Metastases contraindicate resection, in which case chest tubes are inserted, the wound is closed, and chest tubes are connected to a sealed drainage unit.

4.  The mediastinal pleura is dissected free.

5.  The bronchus, pulmonary artery and veins are ligated.

6.  The bronchial stump is clamped, transsected and sutured or stapled.

7.  Lymph node-bearing tissues are excised as necessary.

8.  Hemostasis is achieved.

9.  Chest is closed in interrupted layers.

Instruments

•   Major procedures tray 

•   Thoracotomy tray 

•   Vascular procedures tray 

•   Hemoclip appliers, assorted sizes, long handled 

•   Long Pean clamps 

•   Stapling devices 

•   Cushing vein retractors 

•   Basin set 

•   Suction tubing 

•   Blades (3) No. 10, (1) No. 15 

•   Dissectors

•   Asepto syringes (2) 

•   Staples

•   Hemoclips

•   Vessel loops, umbilical tapes 

•   Chest drainage tube(s) 

•   Connector for example, straight or large Y 

•   Sealed drainage unit.

Any questions be sent to drmmkapur@gmail.com

All older posts are stored in archive for accessand reiew

Thosewho follow may post contributions to the site,please writo tp address above.

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Thoracic Surgery Lobectomy Lung

Pulmonary Lobectomy

Objective

In cases of benign or malignant lesion limited to a lobe:

•   Excision of one or more lobes of the lung bearing the tumor.

Position

Lateral.

Anesthesia

General.

Procedure

   1.  Lung is exposed through a posterolateral incision.

   2.  Diseased lobe is identified.

   3.  The visceral pleura is dissected free from the hilus.

   4.  The pulmonary artery and vein of the diseased lobe are ligated and divided.

   5.  The bronchus is isolated, doubly clamped and transsected.

   6.  Bronchial stump is sutured; more frequently a stapling device may be employed.

   7.  The suture line is tested for air leaks.

   8.  Hemostatis is achieved.

   9.  Chest tubes are inserted.

10.  Chest is closed in layers.

11.  Chest tubes are connected to a sealed drainage unit.

Instruments

•   Major procedures tray 

•   Thoracotomy tray 

•   Vascular procedures tray 

•   Hemoclip appliers, assorted sizes, long handled 

•   Long Pean clamps 

•   Stapling devices 

•   Cushing vein retractors 

•   Basin set 

•   Suction tubing 

•   Blades (3) No. 10, (1) No. 15 

•   Dissectors

•   Asepto syringes (2) 

•   Staples

•   Hemoclips

•   Vessel loops, umbilical tapes 

•   Chest drainage tube(s) 

•   Connector for example, straight or large Y 

•   Sealed drainage unit.

Any questions be sent to drmmkapur@gmail.com

All older posts are stored in archive for accessand reiew

Thosewho follow may post contributions to the site,please writo tp address above.

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Thoracic Surgery segmental resection lung

Segmental Resection of the Lung

Objective

In cases of benign or malignant disease of lungs:

•   Excision of anatomic subdivisions of the pulmonary lobes bearing the tumor.

Position

Lateral (diseased side up).

Anesthesia

General.

Procedure

   1.  Posteriolateral incision.

   2.  Diseased segment is identified.

   3.  The visceral pleura is dissected free from blood vessels and bronchi of the appropriate bronchiopulmonary segment.

   4.  Segmental pulmonary vein and segmental branches of the pulmonary artery are ligated.

   5.  The segmental bronchus is isolated, doubly clamped, and transsected.

   6.  Bronchial stump is sutured or stapled.

   7.  Pleural space is irrigated.

   8.  Hemostasis is achieved.

   9.  Chest tube is inserted.

10.  Wound is closed in layers.

11.  Chest tube is connected to a sealed drainage unit.

Instruments

•   Major procedures tray 

•   Thoracotomy tray 

•   Vascular procedures tray 

•   Hemoclip appliers, assorted sizes, long handled 

•   Long Pean clamps 

•   Stapling devices 

•   Cushing vein retractors 

•   Basin set 

•   Suction tubing 

•   Blades (3) No. 10, (1) No. 15 

•   Dissectors

•   Asepto syringes (2) 

•   Staples

•   Hemoclips

•   Vessel loops, umbilical tapes 

•   Chest drainage tube(s) 

•   Connector for example, straight or large Y 

•   Sealed drainage unit.

Any questions be sent to drmmkapur@gmail.com

All older posts are stored in archive for accessand reiew

Thosewho follow may post contributions to the site,please writo tp address above.

To create consumer/provider enagement visit www.surginstruatlas.blogspot.co

www.drmmkapur.blogspot.com                 www.surgseminar.blogspot.com

Also available now on android & smartphones same internet addres

Thoracic surgery Mediastinoscopy

Mediastinoscopy

Objective

In cases of suspected malignancy:

•   Endoscopic visualization of the mediastinum (tracheobron­cheal junction, bronchi, aortic arch and regional lymph nodes) 

•   Biopsy if required.

Position

Supine.

Anesthesia

General.

Procedure

1.  Transverse incision over the suprasternal notch and extended down to the pretracheal fascia. 

2.  Blunt dissection the superior mediastinum is entered.

3.  Scope is passed.

4.  Avoid injury to nearby blood vessels.

5.  Lymph node tissue biopsied.

6.  Hemostasis is achieved.

7.  Scope is removed.

8.  Wound is closed.

Instrument

•   Mediastinoscope (Fig. 19.11)

•   Electrosurgical unit 

•   Suction

•   Fiberoptic light source 

•   Basin set 

•   Blade (1) No. 15 

•   Telfa dressing pads and 22 gauge needle

Any questions be sent to drmmkapur@gmail.com

All older posts are stored in archive for accessand reiew

Thosewho follow may post contributions to the site,please writo tp address above.

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Also available now on android & smartphones same internet addres. 

Thoracic surgery bronchoscopy

THORACIC OPERATION

Bronchoscopy

Objective

In cases of suspected bronchial lesions:

•   Endoscopy

•   For visualization of the trachea, main bronchi and their openings and the segmental bronchi 

•   Obtaining material for histopathologic and bacteriologic examination if required 

•   Foreign body removal.

Position

Supine.

Anesthesia

General.

Procedure

1.  The head is lowered.

2.  Well-lubricated scope is inserted into the mouth.

3.  The epiglottis is elevated with the tip of the bronchoscope and the scope is passed into the trachea.

4.  The scope is advanced into the bronchi.

5.  Bronchial washings, biopsy, may be obtained.

6.  The bronchial passages are well suctioned, and the scope is removed slowly.

Instruments

Rigid bronchoscopy

•   Rigid fiberoptic bronchoscope (Fig 19.8)

•   Endotracheal adaptor 

•   Fiberoptic telescope 

•   Fiberoptic light cords (2) 

•   Suction cannula (Fig. 19.9) 

•   Suction tubing 

•   Specimen collectors 

•   Biopsy forceps 

•   Sponge carriers (2) (Fig. 19.10)

•   Grasping forceps 

•   Lubricant

•   Bronchoscopy sponges 

•   Small basin with sterile saline and syringe 

•   Telfa dressing pads and 25 gauge needle 

•   Laser may be employed.

Flexible bronchoscopy

•   Flexible fiberoptic bronchoscope 

•   Endotracheal adaptor 

•   Fiberoptic light cord 

•   Biopsy forceps 

•   Brush

•   Culture jar for biopsy specimen 

•   Small basin with sterile saline and syringe 

•   Suction tubing 

•   Specimen collector 

•   Lubricant

•   Telfa dressing pads and 25 gauge needle.

Any questions be sent to drmmkapur@gmail.com

All older posts are stored in archive for accessand reiew

Thosewho follow may post contributions to the site,please writo tp address above.

To create consumer/provider enagement visit www.surginstruatlas.blogspot.co

www.drmmkapur.blogspot.com                 www.surgseminar.blogspot.com

Also available now on android & smartphones same internet addres