霍普金斯手术记录：右腋窝淋巴结清扫

Title of Operation:

Right axillary node dissection.

Indications for Surgery:

This patient has a diagnosis of a right breast cancer.  She had a single positive node that was a sentinel node.  Unfortunately, it also had extracapsular extension.  Therefore, a completion node dissection is recommended.福建省立医院基本外科黄东航

Preoperative Diagnosis:

Right breast cancer with a positive node.

Postoperative Diagnosis:

Right breast cancer with a positive node.

Anesthesia:

General by LMA with 0.25% Marcaine in the wound.

Specimen (Bacteriological, Pathological or other):

Right level 1 and 2 axillary node dissection.

Prosthetic Device/Implant:

None.

Surgeons Narrative:

Assistant Surgeon:  ***.

EBL:  400 cubic centimeters.

Drains are one 15-French Blake drain in the right axilla.

Complications are none.

Findings:  The patient has the thoracodorsal nerve artery and vein and a long thoracic nerve were identified and preserved throughout their length in the axilla.

The patient was brought to the operating room, placed in supine position on operating table where general anesthesia was induced. The right arm and axilla were prepped and draped in usual sterile manner.  The area was anesthetized with 0.25% Marcaine and Lazy-S incision was made, which took a small ellipse around the prior scar.  After making this incision, superior and inferior flaps were created superficial to the clavipectoral fascia.  I then dissected over and identified the lateral border of the pectoralis major muscle and the lateral border of the latissimus dorsi muscle.  She had a relatively large vein extending from around her pec. This was clipped and divided.  After clearing these areas, the pectoralis major muscles retracted medially that allowed access to level 2, level 2 nodes were brought into level 1 of the axilla.  There were a couple of enlarged nodes in this location, but they were not firm, I then included the clavipectoral fascia and identified the axillary vein.  The dissection was then carried out inferior to the axillary vein. As I cleared the level 2 nodes into level 1 of the axillae, I then dissected along the chest wall to identify the long thoracic nerve.  After this nerve was identified and preserved throughout its length in the axilla, I then dissected further laterally along the axillary vein to identify the thoracodorsal nerve, artery, and vein.  After identifying this neurovascular bundle, I dissected the fat pad off between the two nerves, off the subscapularis muscle and brought them as a part of the specimen, I then dissected laterally to the latissimus dorsi muscle completing the left level 1 and 2 axillary node dissection. After excising that tissue, the wound was irrigated.  Hemostasis was ensured using clips and electrocautery.  A 15-French Blake drain was placed through a separate stab wound.  The deep dermal layer was approximated using 3-0 Vicryl sutures and the skin was closed with running 4-0 subcuticular stitch.  All needles, instruments, and sponge counts were correct at the conclusion of the procedure.  The patient then awakened from the operating room, extubated, and taken to recovery room in stable condition.

CLINICAL STAGE OF TUMOR:

T1 N1 M0 right breast cancer.

CC List: