Back Table Setup for an Open Umbilical Hernia Repair

Surgical instrument tables are considered as basic furniture for the operating room (OR). The largest table, typically rectangular or "L"-shaped, serves as a central hub for arranging and storing sterile supplies until needed during surgical procedures. The Mayo stand is an extension of the large table. It is small, height-adjustable, and intended to hang over the operating table and hold instruments and other sterile items for immediate use and within easy reach for the scrub nurse. Both the large table and the smaller Mayo stand are often referred to as back tables.¹

The specific equipment and arrangement of the back table may vary depending on the type of surgery and the surgeon's preferences. It is important to ensure that the equipment is adequate but not excessive, allowing for maximum efficiency with minimal effort. Modern OR equipment is made of unpainted, corrosion-resistant metal, which is long-lasting and easy to clean. In addition, most tables have casters, which are usually made of conductive material such as metal or conductive rubber, to allow for quiet movement with minimal effort. The conductive nature of the casters and floors contributes to a safe environment in the OR.

This video provides a detailed, step-by-step guide to the back table setup for an open umbilical hernia repair surgery. It covers the preparation of the surgical field, the handling of sterile supplies, and the organization of the surgical tray. Additionally, it discusses the importance of adhering to sterile technique and the surgeon's preferences during the procedure.

Before starting the procedure, it is essential to prepare the surgical environment. This involves ensuring that all necessary supplies and equipment are available and organized. The surgical team should wear appropriate sterile attire, including gowns and gloves, to maintain a sterile environment. It is crucial to handle these sterile supplies with care to prevent contamination.

The initial part of this video describes the process of opening a standard basic pack used in surgical settings. The pack typically has two shades of blue: dark blue for sterile areas and light blue for non-sterile areas. The dark blue areas are not to be touched, while the light blue areas are considered non-sterile and can be touched. The process involves carefully opening the pack and ensuring that the sterile items inside remain untouched. It is important to maintain a distance from the table to prevent the opened items from bouncing off. Also, smaller items should be opened first to prevent larger items from bouncing off. If a package rips during the opening process, it should be discarded and replaced with a new one to avoid contamination. The overall goal of the process is to maintain sterility.

After opening the sterile supplies, it's crucial to inspect them for any damage or defects, such as rips or holes in the packaging. Any compromised items should be discarded immediately to avoid the risk of contamination. The process also involves organizing the supplies neatly to ensure efficiency during the procedure. Special attention is given to handling trays, ensuring that tags are removed without touching the sterile interior. Additionally, filters should be checked for any signs of damage before use, with verification typically conducted by a circulating nurse. Organizing the surgical tray instruments and supplies taking into account the surgeon's preferences and the specific needs of the surgeon is essential for efficiency during the procedure.

Subsequently, Kelly forceps, Pean clamps, Allis clamps, and Kocher clamps are prepared, as they may be needed during the procedure. The Bovie tip, which is used for cauterization, is also prepared. Finally, the preparation of Army-Navy and Goelet retractors, which are used to hold back tissue during the procedure, is discussed. It is suggested to have both types available, along with any other retractors that may be needed (e.g., Farabeuf retractor or Weitlaner self-retaining retractor). Stickers and a pen are kept at hand for labeling medications that may be used during the procedure. A needle driver and straight Mayo scissors are prepared, and sutures are cut into pieces, usually thirds, to facilitate their use during the procedure. Medications, including local anesthetics, are prepared and labeled immediately before being handed off. The medications are always checked with the circulating nurse before accepting them. Finally, all the necessary instruments, sutures, and lap sponges are counted. It is ensured that all necessary instruments are available and that the surgical team is properly dressed and prepared for the surgical procedure.

This video aims to serve as a valuable resource for medical professionals to have a comprehensive overview of the back table structure. A thorough understanding of surgical procedures is essential for developing OR systems, as well as improving surgical standards and patient safety. Establishing standards for instrument tables and ongoing communication between personnel are vital for a smooth and successful medical procedure. The implementation of standardized layouts may allow for faster orientation when a table is handed over between rotating personnel during lengthy procedures.²