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Pilonidal Cyst Excision mayo stand and back table surgery setup

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setup author

Surgery setup images for Pilonidal Cyst Excision

Pilonidal Cyst Excision surgery instruments

Clamping & Occluding instruments

Penetrating Towel Clamp
Penetrating Towel Clamp
Curved Hemostat
Curved Hemostat
Allis Forceps
Allis Forceps

Cutting & Dissecting instruments

#3 Knife Handle
#3 Knife Handle
Metzenbaum Scissor
Metzenbaum Scissor
Straight Mayo Scissor
Straight Mayo Scissor

Grasping & Holding instruments

Toothed Forcep
Toothed Forcep
Adson Forceps
Adson Forceps

Retracting & Exposing instruments

Freer Skin Hook
Freer Skin Hook
Army-Navy Retractor
Army-Navy Retractor

Suctioning instruments

Yankauer Suction
Yankauer Suction

Suturing & Stapling instruments

Mayo-Hegar Needle Holder
Mayo-Hegar Needle Holder

What to expect during Pilonidal Cyst Excision

Pilonidal cyst excision surgery is a procedure aimed at removing a cyst that forms near the tailbone, known as the pilonidal cyst. This cyst can cause pain, swelling, and sometimes infection.

Positioning: Prone

Drapes: 4 Towels with towel clips or 4 towel drapes, laparotomy drape

Step 1: Preparation and Positioning

Begin by placing several pieces of silk tape or similar material to gently separate the buttocks, ensuring optimal visualization of the pilonidal cyst location. Once the patient is prepped and draped, suction tubing and a bovie should be passed off the sterile field and plugged in for immediate use during the procedure.

Step 2: Incision and Dissection

Using a 10 blade loaded on a #3 knife handle, make a wedge incision. Use toothed forceps and the bovie to carefully dissect around the pilonidal cyst. Skin hooks provide superficial retraction, transitioning to Army-Navys for deeper retraction as needed. An Allis clamp is beneficial for grasping tissue edges for maneuvering purposes.

Step 3: Smoke Evacuation

Prioritize safety by utilizing a yankauer attached to suction tubing while employing the bovie to prevent inhalation of surgical smoke.

Step 4: Cyst Dissection

Exercise caution to avoid dissecting into the cyst itself. Instead, meticulously dissect around it to ensure complete removal without spilling contents into the incision. Expect to encounter hair and fluid within the cyst.

Step 5: Achieving Hemostasis

Following cyst removal, utilize the bovie further to achieve hemostasis in the surrounding tissue, ensuring minimal bleeding.

Step 6: Closure Technique

The closure technique plays a pivotal role in successful healing. Utilize 2-0 and 4-0 Vicryl, 4-0 Monocryl, and 3-0 Nylon for closure. Instruments such as the Mayo Hegar needle driver, adsons or rat tooth pickups, and straight mayo scissors are used during the closure process. Pay careful attention to achieving precise closure to promote optimal healing outcomes.

The Surgery Sparknotes
  1. Preparation and Positioning: Apply silk tape to separate buttocks. Prep and drape patient. Set up suction tubing and bovie.
  2. Incision and Dissection: Make wedge incision with 10 blade. Use toothed forceps and bovie for dissection. Use skin hooks and Army-Navys for retraction.
  3. Smoke Evacuation: Use yankauer on suction tubing while bovie is in use to prevent inhalation of surgical smoke.
  4. Cyst Dissection: Dissect carefully around cyst to avoid spillage. Expect hair and fluid within cyst.
  5. Achieving Hemostasis: Utilize bovie for hemostasis in surrounding tissue post-cyst removal.
  6. Closure Technique: Close with 2-0 and 4-0 Vicryl, 4-0 Monocryl, and 3-0 Nylon. Use Mayo Hegar needle driver, adsons or rat tooth pickups, and straight mayo scissors for closure.

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