Jejunostomy Tube (J-Tube) Insertion

The case

Walkthrough

What the surgeon does — and what to have in your hand before they ask.

1. 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.

2. 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.

3. 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.

4. 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.

5. 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.

6. 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.

7. 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.