Mayo stand and back table instruments for Colostomy/Stoma Creation/Ileostomy surgery setup

Clamping & Occluding

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  Curved Hemostat

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  Tonsil Clamp

Cutting & Dissecting

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  Curved Mayo Scissor

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  Metzenbaum Scissor

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  Straight Mayo Scissor

Grasping & Holding

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  Adson Forceps

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  Allis Forceps

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  Babcock

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  Bonney Forceps

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  Forester Sponge Forceps

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  Toothed Forcep

Retracting & Exposing

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  Army-Navy Retractor

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  Richardson Retractor

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  Senn Retractor

Suctioning

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  Poole Suction Probe

Suturing & Stapling

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  Mayo-Hegar Needle Holder

What to expect during Colostomy/Stoma Creation/Ileostomy

A colostomy, stoma creation, or ileostomy is a surgical procedure that involves creating an opening in the abdomen and bringing a part of the large or small intestine through the opening to create a stoma. The stoma allows stool to pass out of the body and into a colostomy bag or pouch, which is attached to the skin around the stoma. This procedure is usually done after a colon resection or colectomy, and it is performed when the normal route for stool to exit the body is blocked or damaged.

Positioning
Supine

Drapes
Folded towels or 4 utility drapes, laparotomy drape

Step 1: Making the Incision
To begin the procedure, the surgeon will make an incision in the lower abdomen using a 10 or 15 blade. The surgeon will then use a bovie with adsons with teeth or a heavier pickup such as rat-tooths or Bonneys to grasp the tissue. Small retractors such as skinny Richardsons or senns will be used to retract.

Step 2: Creating the Stoma Incision
Once the initial incision is made, the surgeon will make another incision through the anterior rectus sheath using a fresh blade. A hemostat or tonsil will be used to separate the tissue, and the previously cut bowel will be pulled through the stoma incision using a Babcock or an Allis.

Step 3: Cutting the Staple Line
The bowel would have been stapled and cut prior during the colon resection portion of the surgery. Now, a fresh blade will be used to cut that staple line off, and the edges can be clamped or loosely sutured to the stoma incision. Absorbable sutures can then be used to suture the stoma.

Step 4: Attaching the Colostomy Bag
Finally, the circulator will open up the unsterile colostomy bag to you, and the surgeon will use curved or straight Mayo scissors to cut it to the appropriate circumference. The colostomy bag will be attached to the patient, and the stoma creation is complete.

Tips and tricks
As a surgical technologist preparing for a Colostomy/Stoma Creation/Ileostomy procedure, it’s important to keep the dirty instruments separate from the clean ones. One best practice is to have a separate “closing table” for closing the abdomen. This table should include Mayo scissors, a variety of clamps, needle drivers, suture, irrigation, clean laps, and clean gloves. By keeping these items separate, you can ensure that the sterile field is maintained throughout the procedure.

The Surgery Sparknotes

1. Make incision in lower abdomen using a 10 or 15 blade and retract tissue with adsons or pickups and skinny retractors such as Richardsons or senns.
2. Create stoma incision through anterior rectus sheath, pull cut bowel through with a Babcock or an Allis.
3. Cut staple line with fresh blade, clamp/loosely suture edges, and suture the stoma with absorbable sutures.
4. Attach colostomy bag to the patient by cutting it with curved or straight Mayo scissors.