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Excisional Biopsy of Right Breast With Needle Localization Operative Transcription Example

PROCEDURE IN DETAIL:  On the day of surgery, the patient was taken first to the x-ray department where she underwent needle localization with appropriate imaging provided.  The patient was then brought to the operating room afterwards, placed supine on the operating table.  After administration of adequate anesthesia, area of the right breast was prepped and draped in the standard surgical fashion.  A small elliptical incision was made encompassing the area of the needle localization, which was in the lower outer quadrant of the breast, and the incision was carried down to the skin and subcutaneous.  Bovie electrocautery was used to maintain hemostasis.  Gentle skin flaps were created on both sides using Bovie electrocautery.  The area of the wire was then grasped with an Allis retractor and mobilized the breast tissue encompassing area of question on the mammographic finding, was then brought down and dissected free from the surrounding tissue.  A specimen encompassing the area where the lesion was visualized on the mammogram film was then placed with the wire and removed.  The cavity was inspected.  The specimen was placed on a grid and sent to Radiology for examination.  After inspecting the cavity, it was felt there was a possibility that the lesion was still in the deep aspect of the cavity and therefore the decision was made to remove an extra amount of breast tissue from the deep cavity.  Excision was then performed removing this hardened breast tissue, which was likely corresponding to the area of the mass.  Therefore, this area of the mass was not sent off with the initial wire and specimen.  It was felt that there was a possibility that the wire and specimen would not contain the mass.  A wide excision of the area of the hardness and mass was then performed.  This was sent off as a separate specimen to Pathology and labeled as deep margin of excision.  The area of the cavity was then inspected.  Excellent hemostasis had been achieved.  Small clips were placed in the cavity.  The wound was gently irrigated with local anesthetic of 1% lidocaine mixed with 0.5% Marcaine.  Skin was also infiltrated with local anesthetic.  The deep dermal layer was brought together with interrupted 3-0 Vicryl suture.  The skin was brought together with 4-0 Vicryl subcuticular suture and Steri-Strips and a sterile dressing were applied.  The patient tolerated the procedure well, was awakened, and brought to the recovery room in stable condition.