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Part A: Answer each of the following questions in one or two paragraphs.

1. Code the following operative report.

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Preoperative Diagnosis: Left flank soft tissue mass

Postoperative Diagnosis: Left flank soft tissues mass

Surgeon: John Doe, DO

Operations: Excision of left flank soft tissue mass with layered closure measuring 4 cm , with margins, prior to excision

Anesthesia: sedation with 1% lidocaine with epinephrine and sodium bicarbonate

Operative Indications: this is a pleasant female who come in with soft tissue lesion in the left

flank over what appeared to be a Spigelian Hernia site as well. However, it was not reducible and did not appear to be consistent with a hernia. Consequently, the procedure, risk, benefits, and alternative of excision of this lesion were discussed with the patient, and she understood and wished to proceed with the excision.

Operative Findings: Large soft tissue lesion measuring about 6 cm in greatest dimension

Operative procedure: The patient was brought into the operation room after informed consent was obtained. The patient then underwent sedation with a sterile prep and drape. We then anesthetized with 1% lidocaine with epinephrine and sodium bicarbonate, made a 4-cm incision, and used sharp dissection to dissect circumferentially around this soft tissue lesion, being careful to make sure that we were not entering any kind of hernia sac secondary to Spigelian hernia. As we continued to dissect circumferentially around it without sharp dissection, it was noted that it did go down to a muscle, but no evidence of hernia was identified. The lesion was excised in its entirety and electrocautery was used to control hemostasis. We then irrigated with saline solution and closed the subcutaneous tissue with 3-0 Vicryl interrupted and sutures. We then used 4-0 Vicryl sutures to close the skin in a subcuticular fashion. Benzoin and Steri-Strips were then applied. Blood loss was minimal. The patient tolerated the procedure well and remained in stable condition throughout the procedure.