Pre-op Diagnosis: Morbid obesity (CMS/HCC) [E66.01] Body mass index is 43.75 kg/m². Essential hypertension, OSA with cpap
Post-op Diagnosis: Same as Pre-op
Procedure(s): Procedure(s):
SLEEVE GASTRECTOMY ROBOTIC ASSISTED
Proc. Description(s) & CPT Code(s): SLEEVE GASTRECTOMY ROBOTIC ASSISTED:
Anesthesia: General
Estimated Blood Loss: None
Quantitative Blood Loss: No data recorded
Drain: None
Complications: none
Findings: Liver appeared fatty
Technique:
Tonie Williams is electively admitted for robotic sleeve gastrectomy today for obesity and health problems directly related to obesity. The patient has been extensively informed of the risks, benefits, limitations, and alternatives to surgery as a means of aggressive weight control through discussions in the Tulane Weight loss Center.
PROCEDURE: After an informed consent was obtained from Tonie Williams, the patient was brought to the OR and placed under general endotracheal anesthesia. A timeout was used to confirm the appropriate patient and procedure. Bilateral lower extremity SCDs were placed. The patient was given antibiotics intravenously prior to the operation. A 36French visigi tube was advanced into the stomach. The abdomen was prepped and draped in the standard fashion. We entered the peritoneal cavity with an 5-mm optical trocar in the left upper quadrant near the umbilicus and insufflated the peritoneum to 15 mmHg. Under laparoscopic visualization, we placed a 8-mm trocar near the left costal margin, a 8-mm trocar in the left upper quadrant, a 12-mm trocar in the right upper quadrant. We upsized the original 5mm trocar was upsized to an 8mm trocar. We made a 5mm incision just inferior to xiphoid. All the incision sites were infiltrated with 0.25% bupivacaine with epinephrine before making the incisions. We placed a nathanson/iron intern through the 5mm incision inferior to xipoid to elevate the liver.
TheDa Vinci robot was brought into the field over the LEFT shoulder, with arms connecting tothe RUQ and LUQ ports. We began taking the omentum off the greater curvature of the stomach, we entered the lesser sac. The omentum was taken off the stomach proximally to the left crural pillar and distally to approximately 4 cm from the pylorus.
We orally passed a #36-French visigi down into the antrum. With the visigi against the lesser curve, we divided the stomach beside the tube. We used a 60-mm blue load once, and then 60mm white loads to completed divide the stomach. The staple lines were carefully inspected and found to be well formed with no serosal tears. The staple line was covered with vistaseal. We then withdrew the gastric specimen through the right upper quadrant incision. We then closed the fascia at this site with a #0 vicryl suture using the M close fascial cloure device. The robot was undocked, the liver retractor was withdrawn. We removed the trocars under laparoscopic visualization. The sponge, needle, and instrument counts were correct. The incisions were closed with 4-0 Monocryl subcuticular sutures and covered with Dermabond. The patient was taken to the recovery room in stable condition. I was present and participated directly in all aspects of the operation.
CPT and ICD-10 code:
43775 LAPAROSCOPY, SURGICAL, GASTRIC RESTRICTIVE PROCEDURE; LONGITUDINAL GASTRECTOMY (IE, SLEEVE GASTRECTOMY)
E66.01 – Morbid (severe) obesity due to excess calories (CMS/HCC)