Mayo stand and back table instruments for Laparoscopic Hemicolectomy surgery setup

Clamping & Occluding

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  Babcock

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  Curved Hemostat

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  Kocher Forceps

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  Laparoscopic Clip Appliers

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  Mosquito Clamp – Curved

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  Tonsil Clamp

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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  Adson Forceps

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  Allis Forceps

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  Debakey Forceps

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  Dissecting Laparoscopic Grasper Forceps

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  Laparoscopic Bowel Grasper

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  Laparoscopic DeBakey Forceps

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  Laparoscopic Hunter Bowel Grasper

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  Toothed Forcep

Retracting & Exposing

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  Army-Navy Retractor

Suctioning

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  Suction Irrigator

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  Yankauer Suction

Suturing & Stapling

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  Mayo-Hegar Needle Holder

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  Ryder Needle Holder

What to expect during Laparoscopic Hemicolectomy

Positioning:

Supine

Drapes:

Folded towels, laparotomy drape

Surgery Steps:

An incision with either an 11 blade or a 15 blade on a #3 knife handle will be made inferior to the umbilicus, followed by the use of a Kocher clamp used to elevate the tissue in order to use the blade again to finish the incision. A UR-6 suture is commonly used on both sides of the incision, clamped with hemostats on the end. Metz will be used to enter into the abdominal cavity. Commonly a 12 mm Hassan is inserted into this incision, and insufflation can be turned on.

After the scope has been white balanced, it can be inserted through the trocar for visualization. Usually around 3 smaller trocars are placed. The patient will then be put into Trendelenburg with their right side up.

A Harmonic is commonly used for taking down attachments and adhesions. Different doctors like different laparoscopic graspers, but commonly used ones are DeBakeys and bowel graspers. These instruments will be used for a large portion of the surgery, taking structures down, and moving them around. The PA, resident, you, or some sort of second person will need to retract using one of the graspers.

Either a reusable or disposable clip applier will be used to clip vessels. Either the Harmonic or scissors will be used to cut them. Sometimes a Ligasure is used.

The umbilical incision will be made bigger using a 15 blade, and an Army Navy retractor can be used to retract. Once the incision has been made to the appropriate size, a wound protector (Alexis) will be placed. The specimen/tumor will be delivered through the Alexis, and a GIA stapler will be used to staple and cut the portion of colon off. The specimen should be considered contaminated since it is colon, so it and the stapler should be placed in a separate area so the rest of your things aren’t contaminated.

A Babcock clamp is placed on the distal side, and the distal ileum will be delivered through the Alexis. The two ends of the bowel are placed together for the anastomosis, and a 75 GIA is commonly used to create the anastomosis.The bovie will be used to create a hole where the stapler can be placed into, and it will be widened with a hemostat or tonsil. An Allis clamp may also be used to help with the stapler placement. The stapler will be fired, and hemostasis is confirmed. Several Allis clamps will be used to help close the rest of the defect with the commonly used TA 60 stapler.

The bowel can be dropped back into the abdomen, and that incision can be closed. The abdomen will be reinsufflated, and the abdominal cavity will be checked for any bleeding, as well as be irrigated and suctioned.

The trocars can be removed, and all incision can be closed. 4-0 monocryl is commonly used.