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Assign оnly the Medicаl аnd Surgicаl sectiоn cоdes PREOPERATIVE DIAGNOSES: 1. Pelvic pain. 2. History of previous pelvic surgery and ovarian cyst. POSTOPERATIVE DIAGNOSES: 1. Pelvic pain. 2. History of previous pelvic surgery and ovarian cyst. OPERATION PERFORMED: Laparoscopic adhesiolysis. SURGEON: Susan Smith, MD ANESTHESIA: General endotracheal. ESTIMATED BLOOD LOSS: Less than 10 mL URINE OUTPUT: 70 mL IV FLUIDS: 750 mL DESCRIPTION OF OPERATION: After informed consent was obtained, the patient was taken to the operating room. She was placed in the dorsal supine position and general anesthesia was induced and prepped and draped in the usual sterile fashion. A Foley catheter was placed to gravity and speculum was placed in the posterior and anterior vagina and the cervix was grasped with a single-toothed tenaculum. A Hulka clamp was then inserted through the cervix into the uterus for uterine manipulations and the tenaculum was removed and attention was then turned to the abdomen. A supraumbilical incision was made with a scalpel and elevated up with towel clamps. A long Veress needle was then placed and CO2 gas was used to insufflate the abdomen and pelvis. A 10-12 trocar and sleeve were then placed and confirmed via the laparoscope. The dense greater omental adhesions to the anterior abdominal wall were noted immediately. At this time, we were not able to see into the pelvic region. A second 5 mm trocar and sleeve were placed in the left mid quadrant under direct visualization. The ligature device was then placed developing a plane between the omentum and the anterior abdominal wall. The adhesiolysis took place and it took approximately 25 minutes to release all of the omental adhesions from the anterior abdominal wall. We were then able to visualize the pelvis and a blunt probe was placed through the port. The ovary was visualized and photos were taken with no evidence of any ovarian cyst or ovarian pathology or of pelvic endometriosis. The uterus also appeared normal and the left tube and ovary were surgically absent. The appendix was easily visualized and noted to be noninflamed, normal in appearance, and there were no adhesions in the right lower quadrant. The upper abdominal exam was unremarkable. The procedure was terminated at this time. The ports were removed. CO2 gas was allowed to escape. The incisions were closed with 4–0 Vicryl suture. The Hulka clamp was removed. The vagina was noted to be hemostatic. The patient was awakened from anesthesia, the Foley catheter was removed, and she was taken in stable condition to the recovery room. ICD-10-PCS code(s):
EXTRA CREDIT - PREOPERATIVE DIAGNOSES: 1. Left leg clаudicаtiоn. 2. Left superficiаl femоral artery оcclusion and femoropopliteal occlusive disease. POSTOPERATIVE DIAGNOSES: 1. Left leg claudication. 2. Left superficial femoral artery occlusion and femoropopliteal occlusive disease. PROCEDURE PERFORMED: A left femoropopliteal bypass (above knee 8-mm PTFE graft with a distal cuff). The patient was brought to the operating room. General anesthesia was given. The left leg was prepped and draped in the usual manner. A vertical incision was made in the groin and the common femoral profunda and superficial femoral arteries were dissected. The femoral artery appeared to be fairly calcified on the back. It was soft on the front. However, close to the inguinal ligament after the inguinal ligament was lifted off basically the external iliac artery was found to be fairly smooth in all directions and appeared to be good place to clamp the artery. The popliteal artery was isolated above the knee through a medial incision in the thigh. Deep fascia was opened. Popliteal fossa was entered. Artery was dissected free of its adjoining veins and was encircled in vessel loops and a tunnel was made. The patient was heparinized, after which the popliteal artery was isolated between clamps and opened longitudinally. Although it had arteriosclerosis and irregular plaque inside, in general it appeared to be open. Anastomosis between the cuff of the graft and the artery was carried out with 6–0 Prolene. The graft was then pulled through the tunnel into the groin. The external iliac artery and two profunda arteries were clamped. A longitudinal incision was made in the common femoral artery. It appeared that on the back of the artery there was a popcorn-type of calcification extending into the lumen of the artery. This popcorn calcification was removed by a limited endarterectomy and after the artery had been smoothed out on the inside, the area was thoroughly irrigated. The arteries were allowed to bleed forwards and backward, after which the graft was cut at an angle and sutured here as a proximal anastomosis, as well, a patch over the artery anastomosis was made with 6-0 Prolene. Air was evacuated and the clamps were released to allow the blood to flow down into the leg. Palpation showed a strong posterior tibial pulse and faint dorsalis pedis. These were palpable by hand. The patient was given protamine. Hemostasis was secured. Irrigation was done and closure was carried out. Vicryl was used for deeper tissues. Skin was closed with surgical clips. Dressings were done. Blood loss was minimal. No transfusion was given. ICD-10-PCS code(s):