CST Surgical Tech Set Ups

This guide is directed solely to the Zimmer system. For a general total knee guide, see www.CSTSetup.com/total-knee-arthroplasty

After incision and dissection the surgeon will start with patella resection. The patella caliper will be used to tell the patella thickness. The patella clamp will be used . . .

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The most common neuroma is found in the foot. They are called a Morton’s neuroma or intermetatarsal neuroma.

For a dorsal approach, the surgeon will make their incision with a 15 blade on the top of the foot. They will dissect down using Adsons, and either Metz or Tenotomy . . .

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An incision will be made around the areola with a 15 blade loaded on a #3 knife handle. Adsons and the bovie will be used to dessert down into the breast tissue. Metz and DeBakeys will also be used.

A variety of retractors will be used, depending on how deep . . .

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A Percutaneous Nephrolithotomy, aka PCNL is performed when a patient forms kidney stones that are too large or too hard to extract through a regular lithotripsy or ureteroscopy.

The patient will be positioned prone, and a tube will be placed through the urethra into the kidney so the area can be easily seen under x-ray.

A small incision with a 15 blade is made on the patient’s back in the location where the stone is seen under x-ray. Under fluoroscopy, a tube/sheath will be placed through the incision to the kidney.

A nephroscope will then be put through the sheath for direct visualization to the stone. Instruments can be passed through the nephroscope to break up the stone and pull out the pieces.

A stent is usually placed at the end of surgery to help with drainage.

Having an understanding of basic instrumentation that you can have available for a surgery is very important. You can use parts of this setup for close to any general surgery. Here are some basic instruments you should feel comfortable putting on your Mayo stand:

Clamps: keep in mind the tissue the surgeon will be handling when choosing your clamps. Hemostats and Kelleys are safe bets when doing open bowel cases. Kochers are good for aggressively pulling tissue up or together. Tonsils are commonly used for spreading deep tissue before using the bovie, as well as passing ties.

Grasping: Adsons are perfect when handling skin and right below the surface. Once the surgeon has a large incision that is a bit deeper, Rat Tooths/ Toothed pickups will work well. For delicate tissue DeBakeys will be your best bet.

Cutting: it’s always safe to have a pair of straight Mayo scissors. Metzenbaums are also very commonly used on tissue. Most open general surgeries require Metz. Curved Mayo scissors are less commonly used, but may be needed if dealing with thicker tissue.

Retractors: Senns are commonly used for small incisions. Army-Navys and Richardson’s are popular for deep tissue. Weitlaners are perfect for when the surgeon needs a self-retaining retractor, maybe when he doesn’t have another helper.

Suctioning: yankauers are better for larger areas, whereas Frazier’s are perfect for tight/ intricate spaces.

Suturing: Mayo-hegars are your classic needledrivers that can be used in almost any space in general surgery.

The surgeon will make an inter-nasal incision with a 15 or 11 blade on a #3 knife handle.

A variety of scissors (usually Iris), possible a Cottle, and pickups will be used to separate the nasal mucosal lining from the septum. Skin hooks will be used for retraction. During . . .

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A tympanoplasty is done to reconstruct or fix an eardrum that has a hole in it.

An incision behind the ear will be made with a 15 blade on a #3 knife handle. A periostial elevator will be used to elevate the periosteum. Small scissors such as iris or Jorgensen . . .

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Patients are usually sedated or injected with a local anesthetic. Sometimes they are put under general depending on their circumstances.

The surgeon will cut the skin over femoral artery in the groin. Once they dissect down to the artery, they will insert a wire into the femoral artery and pass it up to the aneurysm.

Contrast dye will be used throughout the case so that they can see where they are under x-ray for visualization.

A tube will then be placed over the wire. This is preparing for the graft to be inserted which is the next step.

A sheath is used to insert the graft. Once they see the graft is in the correct spot, the sheath will be removed and the graft will expand into the surrounding artery.

The incision can be closed.

Tips:
The open abdominal AAA set should be close by in case the surgeon cannot do it the way they originally planned.

Have balloons and pigtail sheaths available just in case.

Have contrast dye, heparinized saline, and regular saline on your back table and flush all the wires you get and keep them flushed each time they are used.

Wear lead to protect you from x-ray.

Have ties and clips at the ready in case the surgeon quickly needs them.

To sum up what is happening during an ALIF... the surgeon is working on the spine from the front (anteriorlly) to remove a disc in the lower portion of the spine. A bone graft will be placed where the old disc was removed, and this will force the discs above . . .

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Positioning: Supine with arms out on armbands

Drapes: Towels squaring off site (sometimes attached with a skin stapler or towel clamps), and a breast or universal drape over top

Procedure: The patients are usually intubated with general anesthesia. Incisions can be placed a couple of different places. They can be . . .

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