General Surgical Tech Set Ups

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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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.

Colonoscopies are popularly done by an Endo team, but they can also be done in the OR too.

The patient is usually sedated and placed on their side.

The surgeon will put lubricant on the colonoscope and insert it into the rectum. They will advance the scope through the colon and look for abnormalities.

Colonoscopies are very routine, and usually a simple scope is all you need. Other times the surgeon will want to take biopsies if they see abnormalities. A long snare may be used if there are any polyps, and a long flexible cup forcep may be used if the surgeon wants to take a piece of tissue.

A large syringe filled with saline may be used to flush through the scope if visualization is poor.

Before the patient’s scope is done, they are told to drink clear liquids for around 24 hours before so there aren’t any solid particles in the doctor’s way.

Surgery Steps: An incision is made to make the small bowel accessible, usually with a 10 blade. The mesentery will be cut into and dissected, all while maintaining hemostasis. The affected part of small bowel is found, and removed, usually using either a TA or GIA stapler to connect the two ends of small bowel back together. The resected piece of small bowel should be handed off as a specimen. After hemostasis is ensured, closure will begin in layers.

Extra Equipment: ESU, suction

Drapes: Folded towels, laparotomy drape

Notes: Have long instrument trays available, as well as a Balfour and Bookwalter retractor. Always have different size clips easily accessible. The resected part of the bowel being removed should be kept separate in order to avoid contaminating the rest of the sterile setup. Any instruments that become contaminated with bowel contents should also be taken off of the sterile field. A separate sterile field may be requested for the end of the case for closing, containing extra gowns, gloves, and a minor procedure tray.

The donor kidney will be brought to the OR and will be prepared to be implanted into the recipient. Fat will be cleaned off, and the vessels will be dissected clean and will be shortened to make the anastomosis easier. An aortic cuff may be used if the kidney came from a deceased patient.

The veins need to be reconstructed, and there will be branches that will need to be ligated, but a large renal vein will be kept.

The kidney will either be place in the iliac fossa, or in the retroperitoneum.

An large incision with a 10 blade will be made, and the external oblique muscle and fascia are dissected. The internal oblique and transverse muscles will be divided to expose the peritoneum. The inferior epigastric will be ligated, and the spermatic cord will be preserved.

The renal artery and vein will be anastomosed. The renal vein will be attached to the external iliac vein, usually with a small Prolene suture. The artery will be attached to the external iliac artery. The aortic cuff will be trimmed and fitted to the renal artery, and attached to the arrteriotomy in the external iliac artery.

Now the urinary tract will be reconstructed. The bladder will be incised, and the patients’ ureter is found. An incision is made in it.the donor ureter will be fed through the incision into the bladder and anastomosed with absorbable suture. The bladder incision sis closed, and the bladder is filled to check for leaks.

The tissue will be reapproximated and closed with suture.

Notes: booties should be placed on some mosquitos for clamping suture, and ties should always be available on the sterile field.

 

Long and standard length instruments should both be available since the surgeon will be going pretty deep in the abdomen. Vicryl or silk ties should also be available. Open cholecystectomies often times include a lot of bleeding since most are done laparoscopically unless the patient has an issue that prevents it. This often is due to prior health conditions. The liver likes to bleed a lot, even from the smallest knick. The surgeon will make their incision with a 10 blade on a #3 knife handle. A pair of Metz, adsons with teeth, and the bovie will be used to dissect down to the gallbladder. The gallbladder will need to be dissected from the liver. Ties should be loaded on tonsils ready to pass. Two long, larger clamps such as Kelly’s will be used to clamp across the gallbladder while it is tied and cut off. The clamps also prevent it from spilling bile. Once the gallbladder has been taken out, it should be sent to pathology. The abdomen will be irrigated, all bleeding will be stopped, and the incision will be sutured closed.

The patient will be supine on the OR table.

Folded towels and a laparotomy drape will be used to drape the patient out. The bovie and suction need to be thrown off and attached to the drape.

The surgeon will inject local, and then used a 15 blade to make incision. The bovie, Metz, debakeys, and adsons will be used to dissect down to the hernia. Allis clamps may be used on the surrounding tissue.

The hernia sac may be removed and sent to pathology.

A PDS suture or something similar will be used to closed the hernia.

The rest of the incision will be closed with Vicryl and Monocryl.

Proper imaging should be done before the patient comes to the OR for surgery, but if the patient is opened up and the surgeon finds the cancer has spread throughout the abdomen, they will abort the whole procedure.

The patient will be positioned supine on the OR table, and they will be under general anesthesia.

An incision will be made on their abdomen with either a 15 or 10 blade loaded on a #3 knife handle.

The head of the pancreas will be removed first. You will have multiple specimens during this surgery, so be sure to label everything exactly how the surgeon pronounces them.

Most of the duodenum will be removed, along with the gallbladder, a portion of the bile duct, possibly part of the stomach, and some lymph nodes.

A variety of different abdominal staplers should be ready in the room for these different removals.

The next step is reattaching portions of the abdomen to ensure proper bodily functions. The rest of the pancreas and bile duct is attached to the small intestine, and the rest of the stomach will be attached to the small intestine as well for proper function.

After everything has been reattached, closure of the abdomen can begin.

The patient will be supine with folded towels around incision site, along with a lap drape.

The camera, light cord, insufflation tubing, suction irrigator, and bovie will be passed off and clamped to the drape.

The surgeon will use a 15 or 11 blade to made incisions where the ports will go. Usually 2-3 5mm ports and either a 12mm or 8mm port will be placed.

Bowel or wave graspers will be used throughout the surgery to separate the tissue from the hernia inside the abdomen. Scissors, a Maryland, or a bullet grasper may also be used.

Once the hernia has been emptied of bowel, a piece of mesh is usually place to prevent reoccurrence. Either a mesh tacker or suture will be used to hold it in place.

Once the mesh has been placed, the gas will be turned off, and the port sites will be closed. A monocryl is commonly used for closure, and skin glue is usually used for a dressing.

A 15 or 10 blade loaded on a #3 knife handle will be used to make the initial incision. The doctor will use adsons, Metz, bovie and some smaller retractors to start dissecting through tissue to enter the abdomen.

The spleen will be reached and pulled forward to the incision. All of the spleen attachments and blood vessels will be ligated either with bovie, Metz, or with ties loaded on tonsils or used freehand.

A lot of 0 and 2-0 ties should be available, along with vessel loops.

After all of the attachments have been ligated and removed, the spleen will be passed off as a specimen.

All of the bleeding will be stopped and the incision can be closed. Drains usually aren’t used for splenectomies. Staples are usually used on the skin.