TP Biopsy

PROCEDURE NOTE PATIENT: John Smith MRN: 1234567 DOB: 01/01/1970 DATE OF PROCEDURE: 01 November 2024 PROCEDURE: Transperineal Prostate Biopsy using UroNav fusion SURGEON: Dr. Thomas Kelly ANESTHESIA: Local anesthesia with 1% lidocaine INDICATIONS: Elevated PSA, suspicious findings on MRI. MRI date: 10/20/2024. MRI prostate volume: 45cc. PI-RADS lesions: 2 lesions in the right peripheral zone, 1 lesion in the left transition zone. Most recent PSA: 6.5 ng/mL. FINDINGS: Prostate dimensions 45mm x 35mm x 40mm. Calculated US prostate volume 33cc SPECIMENS: Prostate Needle Biopsy from subsequent sectors: Right base, Right mid, Right apex, Left base, Left mid, Left apex. ESTIMATED BLOOD LOSS: Minimal. ANTIBIOTIC PROPHYLAXIS: None COMPLICATIONS: None DESCRIPTION OF PROCEDURE: After proper informed consent was obtained, the patient was transferred to the procedure room. The patient was positioned in the dorsolithotomy position. The scrotum was elevated anteriorly and taped out of the perineum. The perineum was then prepped with betadine solution. After timeout compliant with universal protocol, a BK ultrasound transrectal probe was placed per rectum and the prostate was visualized. A perineal skin puncture site was identified at the site halfway between the lateral aspect of the prostate gland and the medial aspect of the prostate gland on both the right and left side. A local skin block with a buffered 1% lidocaine was then used to anesthetize either side. Using a PrecisionPoint device, the puncture site on the right was stabilized with a 15-gauge needle and a long spinal needle was used to puncture the subcutaneous tissue and provide local anesthesia with 1% lidocaine. The block consisted of anesthetizing the subcutaneous tissue and an apical block just proximal to the GU diaphragm and levator muscle bilaterally. The prostate gland was sized using ultrasound guidance and found to be 33 cc. Ultrasound and MRI images were then fused using the UroNAV fusion based software platform. Targeted biopsy lesions were then performed using UroNAV guidance. Once this was complete, template biopsy of the prostate gland was performed in the standard transperineal fashion using biplane ultrasound guidance. The rectal probe was then removed. The puncture sites and the skin were dressed with fluff dressing. The patient was monitored by support staff for 15 minutes and found to be doing well without lightheadedness, dizziness, or other complaints. Post-procedure instructions were reviewed and the patient was discharged. The patient was informed that results will be available online via the portal but that he should have a follow-up visit scheduled to review these results if he does not already have one scheduled. I was present during the entire procedure as described above, and personally performed the critical portions.