Mayo stand and back table instruments for Jejunostomy Tube (J-Tube) Insertion surgery setup

Clamping & Occluding

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  Curved Hemostat

Cutting & Dissecting

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  #3 Knife Handle

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  Laparoscopic Metz Scissor

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  Metzenbaum Scissor

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  Straight Mayo Scissor

Grasping & Holding

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  Laparoscopic Bowel Grasper

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  Laparoscopic Wave Grasper

Misc

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  Camera Cord

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  Laparoscope

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  Light Cord

Suturing & Stapling

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  Laparoscopic Needle Holder

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  Mayo-Hegar Needle Holder

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  Tulandi Knot Pusher

What to expect during Jejunostomy Tube (J-Tube) Insertion

Jejunostomy Tube insertion surgery, also known as a J-tube or G-tube, is a medical procedure that involves inserting a medical device into the stomach through the abdominal wall. It is used to provide a direct means of delivering nutrition, fluids, and medications to patients who are unable to consume adequate amounts of food or liquids orally.
 

Positioning
Supine in reverse Trendelenburg

Drapes
Folded blue towels or utility drapes and a laparotomy drape

Step 1: Marking the Ideal Placement Position
Before beginning the Jejunostomy Tube insertion surgery, the surgical technologist will assist in finding the ideal placement position for the J-tube. Typically, this position is in the upper left quadrant of the abdomen. Using a skin marker, the technologist will mark the site for incision.

Step 2: Preparing the Abdominal Wall
To create space for the procedure, an 11 blade loaded on a #3 knife handle will be used to make a small incision in the marked area. Once the incision is made, a Verres needle will be inserted to fill the abdomen with CO2. This process helps to lift the abdominal wall away from the organs, providing better visibility for the surgery.

Step 3: Inserting Trocars and Ports
Using the same 11 blade, the surgical technologist will make small incisions to insert trocars and their ports. Typically, 2 or 3 5mm ports and a 10mm port are used. These ports serve as entry points for the laparoscopic instruments that will be used during the surgery. The trocars and ports facilitate access to the abdomen, enabling the surgical team to work effectively.

Step 4: Manipulating the Colon and Locating the Ligament of Treitz
With the laparoscopic instruments, such as bowel graspers, wave graspers, and lap Metz scissors, the surgeon will manipulate the colon to locate the Ligament of Treitz. This ligament serves as a crucial landmark for determining the placement of the J-tube. The technologist must have hemostats readily available to tag the sutures, ensuring they do not slip back into the abdomen.

Step 5: Creating Suture Configuration and Bringing the Colon to the Abdominal Wall
Once the Ligament of Treitz is found, the surgeon will move approximately 30-40 cm away from it to place the J-tube. An EndoStitch and EndoClose may be used to create a diamond configuration of sutures that will ultimately bring the colon up to the abdominal wall. Alternatively, the surgeon may choose to use laparoscopic needle holders and a knot pusher in place of the EndoStitch and EndoClose. Laparoscopic scissors or EndoShears will be used to cut the sutures as needed.

Step 6: Placing the J-tube
A percutaneous needle will be inserted through the bowel, and the J-tube guide wire will be threaded through the needle. The introducer and tear away sheath will be advanced into the abdomen and then into the bowel, following the guide wire. Afterward, the tear away sheath will be removed, and the J-tube will be placed over the introducer. The introducer will be gently removed, and the sutures will be tied to secure the J-tube in place. A syringe, provided in the J-tube pack, will be used to inflate the balloon on the J-tube, ensuring it remains securely positioned.

Step 7: Closing the Incisions
To complete the surgery, the port incisions will need to be closed. The surgical technologist may use a 4-0 Monocryl or Nylon suture with a Mayo needle driver to close the incisions. Alternatively, skin glue may be used as an alternative closure method. Straight Mayo scissors will be utilized to cut the sutures as necessary.

By following these steps, the surgical technologist can effectively assist during a Jejunostomy Tube Placement, ensuring the smooth progress of the procedure and the well-being of the patient.

The Surgery Sparknotes

1. Mark the ideal placement position on the abdomen.
2. Create space by making a small incision and filling the abdomen with CO2.
3. Insert trocars and ports for laparoscopic instrument access.
4. Manipulate the colon to locate the Ligament of Treitz.
5. Use sutures to bring the colon up to the abdominal wall.
6. Place the J-tube using a percutaneous needle and guide wire.
7. Tie sutures to secure the J-tube and inflate the balloon.
8. Close incisions with sutures or skin glue.