What Does The New Ohio License Look Like?

Esofagectomia

male patient of 60 years, with obvious emaciation, partially offset by total parenteral nutrition. Heavy smoker and alcoholic.
Body lean and no previous intervention.
table top
right thoracotomy to perform an atypical lung resection to assess the nature of a right upper lobe pulmonary nodule. Se all'esame estemporaneo fosse stato positivo per metastasi del carcinoma esofageo, l'intervento si sarebbe concluso, altrimenti si sarebbe proceduto ad esofagectomia del terzo distale dell'esofago, con anastomosi esofago-gastrica termino-terminale toracica.
Strumentario
Container per chirurgia toracica
Container per chirurgia addominale
Divaricatore autostatico OmniTack
Due drenaggi toracici CH 32 + raccordo a 'Y' per la connessione a Pleurevac Sahara
Surgiclip per la legatura dei vasi esofagei e dei vasi linfatici
GIA 80 + ricariche per la resezione polmonare atipica
Vesseloop blu per la repertazione esofagea
Drenaggio peritoneale + raccoglitore
Occorrente per Digiunostomia
Shopping Cart
surgery only for the three phases of the chest, abdominal and thoracic
single count of gauze, needles and sharp
Patient Positioning Chest
For phase 1 and 2, the patient was positioned in left lateral decubitus position, with marked hyperextension ribs. For stage abdominal
the patient was positioned supine with left upper limb abducted by venous and arterial. Practiced
bladder catheterization and a CVC inserted in right jugular. Description of

• I ran the surgical scrub at 7.45, while the anesthesiologist introduced the epidural catheter for analgesia postoperatively.
• I have prepared a single shopping cart for the duration of the intervention.
• skin incision of right posterolateral thoracotomy, partial section of the trapezius muscle and application of large rib-spreader. With tongs
• chiurgo the ring has exposed the area to be resected lung
• pulmonary resections with two charges of around 80
• Enter the anatomical part for extemporaneous histological examination, which proved negative.
• isolation of the esophagus with bipolar and anatomical
• Repertoire esophagus on Vesseloop blue vein ligation
• Azigos drawstring braided absorbable USP 0
• Completion isolation until the esophageal diaphragmatic jatus
• Temporary closure of the thoracotomy and application of steridrape.

• Repositioning the patient in the supine position
• laparotomy xipho sottombelicale
• -positioning retractor Omnitrack
• gastric mobilization and partial vascular isolation with conservation gsstroepiploica left and right. This phase was carried out with Ligasure 10, and bipolar scissors
• expansion of digital jatus diaphragmatic
• Cholecystectomy
• closure of the abdomen

• Repositioning the patient in left lateral decubitus position as described in step previous year.
• Reopening of thoracotomy
• repositioning of the stomach in the chest cavity, passing by esophageal jatus, with the help of pliers ring
• section upstream of the esophagus azigos streak with two straight enterostati
• Packaging of tobacco pouch on the stump proximal esophagus with monofilament 2 / 0 non-absorbable
• attaching the brush head of a circular EEA stapler 25 and close the tobacco pouch
• gastrotomy in the gastric body for the passage of the suture, with two landmarks in monofilament absorbable 3 / 0. Section between the two points with a low potential electric scalpel
• insertion of the suture and leakage of the spur on the posterior gastric
• reunification of the machine and packaging of esophageal-gastric anastomosis termino-lateral
• reinforcement of the anastomosis with monofilament absorbable 4 / 0 and application of the parietal pleura anastomosis for protection as determined by the same wire
• placement of drainage tubes and soft closing of the thoracotomy

intervention Duration: 8 hours

Thanks to my colleague Stephen Cardinals, who continued the operation in the afternoon and completed the above description and colleague Susan Pogliani for technical support.