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Extracorporeal Shock-wave Lithotripsy

DESCRIPTION OF PROCEDURE:  After informed consent was obtained, the patient was taken to the operative suite.  After the induction of anesthesia, she was placed in the supine position and a total of 2000 shocks were delivered at 15 kv to three separate stones. Imaging was done with ultrasound.  There was good sonographic evidence of stone fragmentation.  At the termination of the procedure, she was taken to the recovery room in satisfactory condition.  She will be discharged home today.  Medications will include Norco for pain, and ciprofloxacin.  She will strain her urine.  She will follow up in my office in two weeks.

 

EGD

OPERATIVE TECHNIQUE:  With the patient lying on the left side and under sedation with IV Versed and Demerol, the oral cavity and hypopharynx were first anesthetized with Cetacaine spray.  The flexible video gastroscope was introduced into the mouth and passed under direct vision over the tongue, through the hypopharynx, and into the esophagus, stomach and duodenum.  The scope was slowly withdrawn.  Once within the antrum, two biopsies were obtained.  The scope was retroflexed and withdrawn further in order to examine the fundus and cardia.  The instrument was straightened, reintroduced into the antrum, and then slowly withdrawn through the stomach, esophagus and mouth.

PROCEDURE IN DETAIL:  The patient was sedated with Versed and Demerol. After adequate sedation, the hypopharynx was anesthetized with Cetacaine spray.  The Olympus video gastroscope was lubricated with K-Y jelly, introduced per orally into the hypopharynx, and advanced into the esophagus on deglutition.  Under direct vision, the scope was advanced to the lower esophagus, stomach and duodenum.  While withdrawing the scope, the examination was completed.  The patient tolerated the procedure well.

PROCEDURE IN DETAIL:  After the patient was given Versed intravenously, she was placed in the left lateral position.  The throat was sprayed with Cetacaine spray and the gastroscope was introduced into the pharynx and advanced into the esophagus under direct vision.  The proximal and distal portions of the esophagus were examined.  The scope was advanced into the stomach.  Fundus, body and antrum of the stomach were examined.  The scope was retroflexed and the cardia of the stomach was examined.  The scope was advanced into the duodenum and the duodenal bulb and the second part of the duodenum were examined.  The scope was withdrawn.  The patient tolerated the procedure well.

Colonoscopy

PROCEDURE IN DETAIL:  The patient was sedated with Versed and Demerol intravenously.  After adequate sedation, the Olympus video colonoscope was lubricated with K-Y jelly, introduced per anally into the rectum, and advanced under direct vision, manipulating loops of the sigmoid colon, splenic flexure and hepatic flexure up into the cecum.  As the scope was withdrawn, the examination was completed.  The patient tolerated the procedure well.

PROCEDURE:  After the patient was given Versed and Demerol intravenously, she was placed in the left lateral position.  Rectal examination was carried out.  The video colonoscope was introduced into the rectum and advanced into the colon under direct vision.  The scope was advanced through the rectum, sigmoid colon, splenic flexure, hepatic flexure and to the cecum.  As the scope was withdrawn, the entire colon was examined.

 

PEG Tube Placement

PROCEDURE IN DETAIL:    After the patient was given Versed intravenously, she was placed in the supine position and the throat was sprayed with Cetacaine spray.  The gastroscope was introduced into the pharynx and advanced into the esophagus under direct vision.  The proximal and distal portions of the esophagus were examined.  The scope was advanced into the stomach.  Fundus, body and antrum of the stomach were examined.  The scope was retroflexed and the cardia of the stomach was examined.  The scope was advanced into the duodenum and the duodenal bulb and the second part of the duodenum were examined.  The scope was withdrawn back into the stomach.  The stomach was inflated with air and the gastrotomy site was selected on the anterior abdominal wall.  The site was cleansed with Betadine and injected with Xylocaine.  A small incision was made and a needle was introduced into the stomach through the abdominal wall.  A silk wire was passed through the needle and this was grabbed with a snare.  The scope was withdrawn.  The gastrotomy tube was anchored to the silk wire and this was pulled through the abdominal wall in a retrograde fashion.  The tube was anchored to the abdominal wall with outer crossbar and O-ring.  The tube was trimmed and the feeding adaptor was connected.  A dressing was applied.  The patient tolerated the procedure well.  There were no complications noted.

PROCEDURE IN DETAIL:  The patient was sedated with Versed intravenously.  After adequate sedation, the hypopharynx was anesthetized with Cetacaine spray.  The Olympus video gastroscope was advanced into the esophagus on deglutition.  Under direct vision, the scope was advanced to the lower esophagus.  Examination of the esophagus was normal. The scope was advanced into the stomach.  Examination of the stomach was also normal. The duodenum was intubated.  Examination of the duodenum was normal.  The scope was withdrawn into the stomach.  By transillumination, a gastrotomy site was selected over the anterior abdominal wall.  A small incision was made in the skin after cleansing the skin with Betadine solution and infiltrating with 1% Xylocaine.  A 14-gauge needle was introduced percutaneously into the stomach was visualized per gastroscope. The needle was removed and the insertion wire was introduced into the stomach.  The insertion wire was held by the snare passed through the gastroscope.  The insertion wire was anchored to the 20-French gastrotomy tube supplied with the gastrotomy kit.  The insertion wire extruding from the anterior abdominal wall was pulled, pulling the gastrotomy tube in a retrograde fashion into the stomach.  The internal bolster of the gastrotomy tube was felt against the gastric wall. The gastrotomy tube was anchored externally with the crossbar provided with the gastrotomy kit.  The gastrotomy tube was trimmed and connected to the feeding device supplied with gastrotomy kit.  A dressing was applied.