Mayo stand and back table instruments for Rectal Exam Under Anesthesia (EUA) surgery setup

Clamping & Occluding

  • Non-penetrating Towel Clamp

    Non-penetrating Towel Clamp

Grasping & Holding

  • Debakey Forcep

    Debakey Forcep

  • Toothed Forcep

    Toothed Forcep

Misc

  • Camera Cord

    Camera Cord

  • Light Cord

    Light Cord

Retracting & Exposing

  • Hill Ferguson Rectal Retractor

    Hill Ferguson Rectal Retractor

  • Pratt Rectal Speculum

    Pratt Rectal Speculum

  • Sawyer Retractor

    Sawyer Retractor

Suctioning

  • Yankauer Suction

    Yankauer Suction

What to expect during Rectal Exam Under Anesthesia (EUA)

Rectal exams under anesthesia are performed when an office based exam cannot comfortable be done for the patient, or when the physician needs more answers after an in-office exam has been done.

Positioning

Lithotomy

Drapes

Lithotomy drape pack with over the leg drapes

Extra Equipment

Stirrups/Yellofins, light source and camera box if a scope is being used, suction, cautery if needed

Step 1: Preoperative Preparation

Ensure the patient is either given a regional anesthetic or general anesthesia, placing them in the lithotomy position using stirrups or Yellofin leg holders. Utilize Betadine as a standard prep solution for colorectal surgery. Drape the patient with lithotomy drapes and, if applicable, pass off the ends of the suction and cautery to the circulator. Note that these items may not be needed for a digital rectal exam (DRE), typically performed in an office setting but occasionally required in the operating room.

Step 2: Patient Draping

Proceed with draping the patient appropriately for the procedure, keeping in mind the lithotomy position.

Step 3: Initial Examination

The surgeon begins the examination by inserting a lubricated rectal speculum, such as a Hill Ferguson or Pratt, into the rectum. This speculum facilitates continuous visualization throughout the case. If a self-retaining retractor is not used, the surgical technologist or another scrubbed-in individual may need to assist in holding the retractor. The surgeon visually inspects and palpates for any abnormalities, potentially making a diagnosis. In cases where consent is obtained, the surgeon may address and correct fissures or hemorrhoids during the same anesthesia period.

Step 4: Instrumentation for Examination

Ensure the availability of essential instruments for a straightforward rectal exam. These include the specified rectal speculums, sponge sticks with raytecs for cleaning and visualization, Debakeys pickups, toothed forceps, and a yankauer for suction. Confirm the surgeon’s preference regarding the use of a sigmoidoscope for visualization and secure its availability before the patient enters the operating room. If a sigmoidoscope is used, be prepared with a light cord and a light source to illuminate the rectum.

Step 5: Sigmoidoscope Considerations

In cases where the surgeon opts for a sigmoidoscope, inquire about the use of gas during the procedure. Ensure the availability of necessary equipment, such as a light cord with a light source, to adequately illuminate the rectum during the examination.

Step 6: Postoperative Cleanup

Upon completion of the rectal exam, remove the drapes and wash off the Betadine or other prep solution from the patient. Use a wet towel or lap for this purpose, ensuring a thorough and efficient cleanup.

The Surgery Sparknotes

  1. Prep: Administer regional or general anesthesia, place the patient in lithotomy position with stirrups or Yellofin holders, and use Betadine prep solution.
  2. Draping: Drape the patient accordingly, considering the lithotomy position, and be prepared to assist in holding a retractor if needed.
  3. Examination: Insert a lubricated rectal speculum (Hill Ferguson or Pratt) for visualization. Assist with retraction if using a non-self-retaining retractor.
  4. Instruments: Ensure availability of rectal speculums, sponge sticks, Debakeys pickups, toothed forceps, and a yankauer for suction. Confirm the need for a sigmoidoscope and necessary lighting equipment.
  5. Sigmoidoscope: If a sigmoidoscope is preferred, check for the use of gas and ensure availability of a light cord with a light source.
  6. Cleanup: Remove drapes, and wash off Betadine or prep solution using a wet towel or lap.

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