Glancing through the online portal associated with my cancer surgeon, I found a report called “Operative Notes.” The report includes details from surgery — things that I didn’t know, of course, because I was under anesthesia during the procedure — like an itemized list of the specimens that were removed from my body and sent for pathology.
Of particular interest to me is the section entitled “Procedure Details,” which is essentially one long paragraph explaining what happened during surgery. I thought it might interest y’all, as well. I will break it up into multiple paragraphs, for easier reading, but I’m otherwise leaving it as written in the report.
Procedure Details from the Operative Notes:
The patient was brought to the operating room and placed in supine position. After adequate anesthesia, surgical site was verified and surgical pause was taken. Intraoperative ultrasound was used to place a localizing wire at the targeted lesion at 9:00 position. Based on the wire localization, right lateral incision was planned.
After infiltration of the local anesthetic, the incision was made with a scalpel. The electrocautery was used to perform the wide excision including the margin of grossly normal tissue. The excised breast tissue was oriented with sutures, short superiorly and long laterally. This was then imaged intraoperatively using specimen X ray. The X ray confirmed the presence of the biopsy clip and the guidewire in the middle of the specimen.
Additional margins were separately obtained and oriented with sutures. All tissues were sent to pathology for permanent sectioning. Examination of the surgical site revealed no gross abnormalities. Hemoclips were placed in surgical site for marking.
The surgical defect measured approximately 20 square centimeter, which would cause significant deformity of the breast. Decision was made to reconstruct the defect using local advancement flap. Additional incision was made to facilitate the closure of defect. The adjacent tissue was incised superiorly, inferiorly, medially and laterally using electrocautery. Approximately 20 square centimeter of advancement flap was created. The mobilized tissue was advanced to reconstruct the excision defect using 3-0 Vicryl sutures.
Attention was paid to the right axilla. Previously injected blue dye and technetium were used to identify sentinel nodes. An incision was made in the right axilla after local anesthesia. The electrocautery was used to carry the incision down to the clavipectoral fascia, which was divided. Using the gamma probe and visualization of blue dye, a sentinel node was identified and excised. These were sent to pathology. No enlarged or fixed nodes were felt on palpation of the axilla. No additional blue or hot lymph node remained.
Additional local anesthetics were injected. After meticulous hemostasis and irrigation of the wound, the surgical sites were closed in multiple layers using absorbable stitches. Dermabond was applied and the wound was dressed with 4 x 4, and compression wraps.
The patient was able to tolerate the procedure without complications. Postoperatively, the patient was awakened and was transferred to the recovery room in stable condition. At the end of the procedure, all sponge and instrument counts were correct.