Colectomy, Ileorectal Anastomosis mayo stand and back table surgery setup

Colectomy, Ileorectal Anastomosis-sidetable Colectomy, Ileorectal Anastomosis-mayo-stand Colectomy, Ileorectal Anastomosis-backtable

Mayo stand and back table instruments for Colectomy, Ileorectal Anastomosis surgery setup

Clamping & Occluding

  • Allis Forceps

    Allis Forceps

  • Babcock

    Babcock

  • Curved Hemostat

    Curved Hemostat

  • Hemostatic Clip Applier

    Hemostatic Clip Applier

  • Kocher Forceps

    Kocher Forceps

  • MD Anderson Hysterectomy Clamps

    MD Anderson Hysterectomy Clamps

  • Non-penetrating Towel Clamp

    Non-penetrating Towel Clamp

  • Right Angle Clamp

    Right Angle Clamp

  • Rochester Pean Forceps

    Rochester Pean Forceps

  • Tonsil Clamp

    Tonsil Clamp

Cutting & Dissecting

  • #3 Knife Handle

    #3 Knife Handle

  • #3 Long Knife Handle

    #3 Long Knife Handle

  • Metzenbaum Scissor

    Metzenbaum Scissor

  • Straight Mayo Scissor

    Straight Mayo Scissor

Grasping & Holding

  • Adson Bayonet Forceps, tungsten carbide with a tip

    Adson Bayonet Forceps, tungsten carbide with a tip

  • Adson Forceps

    Adson Forceps

  • Debakey Forcep

    Debakey Forcep

  • Ferris Smith Tissue Forceps

    Ferris Smith Tissue Forceps

Misc

  • 0 Degree Scope

    0 Degree Scope

Retracting & Exposing

  • Bookwalter Retractor

    Bookwalter Retractor

  • Farr Spring Retractor

    Farr Spring Retractor

  • Malleable retractor blade

    Malleable retractor blade

  • Richardson Retractor

    Richardson Retractor

  • Wylie Renal Vein Retractor

    Wylie Renal Vein Retractor

Suctioning

  • Andrews Pynchon Suction Tube

    Andrews Pynchon Suction Tube

  • Poole Suction Probe

    Poole Suction Probe

Suturing & Stapling

  • Debakey Needle Holder

    Debakey Needle Holder

  • Mayo-Hegar Needle Holder

    Mayo-Hegar Needle Holder

What to expect during Colectomy, Ileorectal Anastomosis

Colectomy with ileorectal anastomosis is a surgical procedure that involves removing a diseased portion of the colon and connecting the ileum (last part of the small intestine) to the rectum. It is typically performed to treat conditions such as colon cancer, inflammatory bowel disease, or diverticulitis. This procedure aims to restore normal bowel function and improve the patient’s quality of life.

Step 1: Anesthesia
The first step in this surgical procedure is administering general anesthesia to the patient. The anesthesia is used to ensure that the patient is completely unconscious and pain-free during the surgery. Once the anesthesia has taken effect, the surgeon can begin the operation.

Step 2: Incision
The surgeon makes an incision in the abdomen with a 10 or 15 blade on a #3 knife handle, usually in the midline or to the left of the midline. This incision is made to allow the surgeon to access the colon and perform the necessary surgical procedures.

Step 3: Mobilization of the Colon
The surgeon will use a variety of sized retractors such as Richardsons or a Balfour, along with cautery, Ferris Smith forceps, DeBakeys, and metzenblum scissors to dissect down, and then identify the colon and mobilize it from its attachments to the abdominal wall and surrounding structures. This allows the surgeon to access and remove the diseased portion of the colon. Allis clamps, tonsils, and Kochers are also commonly used to manipulate tissue.

Step 4: Ligation and Division
The next step is to identify the blood vessels that supply the diseased segment of the colon and ligate (tie off) them to prevent bleeding. This is commonly done by placing a tonsil clamp or right angle clamp under the vessel, using a DeBakey to place a free tie (2-0 or 3-0 Silk ties) in the jaws of the tonsil or right angle, pulling the clamp back under the vessel, and tying off the suture and cutting it short with a pair of straight Mayo scissors. The colon is then divided above and below the diseased portion, and the diseased segment is removed. A linear cutting stapler is used to do this. The surgeon will tell you what size staple load will be used. The Bovie will be used on the edges if there is any bleeding present.

Step 5: Ileorectal Anastomosis
The surgeon then brings the ileum (the last part of the small intestine) down to the rectum and creates a new connection (anastomosis) between them. A separate prep table or mayo stand should be draped and prepped with some lap or raytecs. The surgeon may use sutures or staples to create the anastomosis. The instruments used during this step include bowel clamps, staplers, and suture material. The most common type of stapler used is an EEA stapler. During this step, the surgeon or an assistant contaminates themselves by going to the smaller prep stand/mayo stand and inserting the stapler through the rectum. The person that’s still sterile (usually the surgeon) will have the anvil (tip of the stapler) loaded onto a Kelley. They will fire the stapler and it will make a “donut” of tissue that is sometimes sent to pathology.

Step 6: Anastomosis Testing
Once the anastomosis has been created, it is tested to ensure that there is no leakage. This is done by filling the area with a sterile fluid and observing for any leakage. The instruments used during this step include syringes and sterile fluid.

Step 7: Closure
The final step is to close the incision in the abdomen with sutures or a skin stapler and apply a sterile dressing. 1 PDS, 2-0 silk, 3-0 silk pop offs for the anastomosis, 3-0 chromic gut, and 3-0 and 4-0 Vicryl are all commonly used. The instruments used during this step include needles, suture material, and staplers.

Tips and tricks
BE SURE TO HAVE LONG VARIATIONS OF CLAMPS FOR DEEP IN THE ABDOMEN.

The Surgery Sparknotes

  1. Make an incision in the abdomen
  2. Mobilize the colon with retractors, scissors, and electrocautery devices
  3. Ligate and divide the blood vessels with clamps, scissors, and electrocautery devices
  4. Create an anastomosis with bowel clamps, staplers, and suture material
  5. Test for leakage using syringes and sterile fluid
  6. Close the incision with needles, suture material, and staplers
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