Mayo stand and back table instruments for Exploratory Laparotomy surgery setup

Clamping & Occluding

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  Allis Forceps

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  Curved Hemostat

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  Kelly Forceps

Cutting & Dissecting

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  #3 Knife Handle

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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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  Debakey Forcep

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  Toothed Forcep

Retracting & Exposing

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  Army-Navy Retractor

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  Bookwalter Retractor

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  Richardson Retractor

Suctioning

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  Poole Suction Probe

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  Yankauer Suction

Suturing & Stapling

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  Mayo-Hegar Needle Holder

What to expect during Exploratory Laparotomy

An Exploratory Laparotomy is a surgical procedure in which a large incision is made in the abdomen to allow the surgeon to examine the organs and tissues inside. It is typically performed to diagnose and treat conditions affecting the digestive system, such as bowel obstruction, tumors, and infections. During the procedure, the surgeon will use various instruments to dissect and retract tissue, identify any problem areas, and resolve any issues found. The incision is then closed in layers, and a drain may be placed to prevent fluid buildup.

Step 1: Making the Incision
To begin the surgery, the surgeon will use a 10 blade to make a large incision in the patient’s abdomen. Once the incision is made, the surgeon will use cautery, Metz, and the variety of pickups to dissect down to the bowel.

Step 2: Retracting and Dissecting
At the beginning of the surgery, the surgeon will use medium and big Richardson retractors to retract the area. Once the area is retracted, the surgeon will use their hands to follow the intestines to locate the problem area. They will use a combination of pickups and cautery to dissect through the tissue as necessary.

Step 3: Identifying and Resolving the Issue
The surgeon will try to find the problem area, which may be a twisted piece of intestine that needs to be repositioned, or a dead part of the bowel that requires resection. In rare cases, the surgeon may not be able to find any issues within the abdomen. Once the problem is identified, the surgeon will resolve it.

Step 4: Closing the Incision
After resolving the issue, the abdomen is usually closed in layers, and a drain may be placed to prevent any excessive fluid and pooling in the abdomen. If the patient is expected to have another surgery or if there is a significant amount of infection, the abdomen may be left open.

Tips and tricks
It is important to ensure that the fluid warmer is set up and ready for use, as saline will be irrigated throughout the entire abdomen during the surgery.

The Surgery Sparknotes

1. Prepare necessary instruments: 10 blade, cautery, Metz, variety of pickups, medium and big Richardson retractors, Bookwalter retractor, and fluid warmer.
2. Make incision with 10 blade and dissect down to bowel.
3. Use pickups and cautery to dissect and retract with Richardson retractors.
4. Identify problem area in intestines and resolve issue, potentially performing resection.
5. Close abdomen in layers and place drain to prevent fluid buildup. May leave open in certain cases.