DATE: @TD@
PATIENT NAME: @NAME@ 


PREOPERATIVE DIAGNOSIS: 
***

POSTOPERATIVE DIAGNOSIS: 
Same

OPERATION: 
***

SURGEON: William Morrel, MD 

ANESTHESIA: General 

INDICATIONS FOR PROCEDURE:  
***

FINDINGS:  
***

DESCRIPTION OF PROCEDURE
The patient was brought to the operating room and consent and identify were verified. General anesthesia was induced and the patient was intubated orally by the anesthesia team without difficulty. A size ***.0 laser-safe ET tube was used. The bed was turned turned 90-degrees. Time-out was performed to confirm the correct patient, procedure, and laterality. Appropriate surgical drapes were placed.

Microsuspension laryngoscopy was performed with a tooth guard in place using the *** laryngoscope. Inspection and further documentation was done with a 0-degree telescope. This also provided for tracheoscopy with the endotracheal tube cuff temporarily deflated. A portion of the papilloma was removed with cup forceps and sent for permanent pathology. 

The operating microscope with the CO2 laser micromanipulator system was then positioned and used for the remainder of the case. Laser-safe precautions were followed throughout the case, which included protective eyewear for the patient and the operating room personnel, appropriate oxygen concentrations (< 35% FiO2), and wet head drapes to protect the patient. Additionally, OR personnel were encouraged to use a finer filtration, laser-safe mask given the history of RRP. The laser was set to a dot with a wattage of *** watts and test-fired on a tongue depressor. Continuous mode was used in Super Pulse. Saline-soaked cottonoids were placed into the subglottis during laser use to protect the ET tube cuff. The laser was used to excise the papilloma using a suction catheter to retract the disease medially. Sessile portions were treated in an ablative fashion. Care was taken to monitor the anterior commissure to prevent thermal damage beyond the midline. All saline-soaked cottonoids were removed at the end of the case and the counts were correct. A laryngotracheal anesthetic was applied with 4% lidocaine using a total of *** mL. The laryngoscope was taken out of suspension and removed, and the patient was returned to the anesthesia team for awakening and extubation. The patient was transported to the PACU awake and in good condition. 

ESTIMATED BLOOD LOSS: *** mL
 
COMPLICATIONS: None ***

SPECIMENS: ***

DISPOSITION:
The patient was transferred to the recovery room in stable condition.