Needle Localized Lumpectomy and SNL
Preop Diagnosis - LEFT/RIGHT breast cancer
Postop Diagnosis - same
Surgeon - Dr. Luk/Dr. Dan Tran
Assistant Surgeon -
Anesthesia - General
Blood Loss - Minimal
Complication - None
Findings - LEFT/RIGHT breast cancer
Sentinel lymph node x
Specimens - same
Procedure Performed- RIGHT/LEFT breast
Needle Localized partial mastectomy
Sentinel Lymph Node Biopsy
Intepretation of Lymphatic Mapping
INDICATION:
RIGHT/LEFT breast cancer
This is a patient with the above diagnosis. The patient was consented for the above procedure. Risks, benefits, and alternatives were discussed with the patient. Risks include, but are not limited to, bleeding, infection, damage to surrounding structures, nerves, or vessels, seroma, hematoma, abscess, dehiscence, lymphedema, discovery of metastasis, and even systemic complications such as cardiopulmonary, thromboembolic, hepatic, renal, neurologic or infectious complications which may even lead to death. All questions were answered. The patient agreed to proceed.
The patient has agreed to undergo a partial mastectomy with sentinel lymph node biopsy.
Patient was brought to Radiology suite where she underwent lymphatic mapping
She also underwent placement of the needle for localization in the indicated breast
I reviewed the film/report prior to surgery.
Patient was given preop antibiotics, she was marked and consent was signed. She was brought to the operating room and she underwent general anesthetic. Time out performed.
She is prepped and draped in sterile fashion.
Sentinel lymph node biopsy
Using the Geiger counter, I identified the area that has a high count in the affected axilla. This corresponds to the imaging.
A small linear incision was performed in the axilla. This was done using 10. Scalpel.
Dissection was carried down to the subcutaneous tissue into the clavipectoral fascia.
Using the Geiger counter, I directed my dissection towards the hottest area.
Eventually we were able to identify the sentinel lymph node was hot and blue.
The node was removed utilizing Harmonic focus maintaining good hemostasis.
This was the sentinel lymph node and was sent off for pathology.
Utilizing a 10% rule, ------- additional sentinel lymph node was removed, it is hot and blue.
Upon completion, this no additional hot, blue, or palpable suspicious symptoms noted.
After ensuring that we had good hemostasis, local anesthetic was injected at the site.
The axillary wound was irrigated and closed using absorbable sutures.
Partial mastectomy
Next we turned our attention to the affected breast.
A semicircular incision was made close to the area where the needle was inserted. This was done using 10. Scalpel.
Dissection was carried down to the subcutaneous tissue using the knife.
Partial mastectomy was performed using the electrocautery maintaining good hemostasis
Specimen was marked with short stitch superior, long stitch lateral, double stitch deep.
It is sent for intraoperative mammographic evaluation, confirming the lesion, clip and wire are in placed.
Pathology noted the gross margin is cleared.
Wound bed was then irrigated with with sterile saline. Irrigation fluid is clean suctioned out. Hemoclips were applied to mark the cavity. We ensured good hemostasis using electrocautery.
At the end of the case, counts were carried out. Instrument, sponge, and needle counts were completed and reported to me as correct.
Before closure of the wound, local anesthetic was injected at the site.
The wound was then closed, the entire length which was about 4 cm with multiple layer of absorbable suture in a layered closure fashion.
Patient tolerated procedure well , no complication, extubated.
She was transferred to recovery in stable satisfactory condition.