Setup for a Laparoscopic Cholecystectomy (Ivy Tech Community College, Indianapolis, IN)

CHAPTER 1

Hi, my name is Maggie Tidd, adjunct faculty instructor here at Ivy Tech Community College. I also am a CSFA at a community hospital here in Indianapolis. Today, I'm going to show you a setup for a laparoscopic cholecystectomy.

CHAPTER 2

So I always start with my laparoscopic cords and I put them all on my Mayo so I don't have to have them on my back table. I have them ready to be handed off, so my camera and mic cord go. My insufflation tubing, and my suction. I go ahead and put that on there. And then I can start setting up my back table. Move this around a little bit. And then I can put a towel down for my instruments. And I'm gonna keep my laparoscopic instruments closer to me 'cause that's what I'm using. Generally we start with a 10, 0. And I'm gonna put that on my Mayo. And my 5, 30 is ready to go. Go ahead and put it in the warmer and get it warm. And then I'm gonna use a clip applier through the case. So I'm gonna go ahead and have that ready. And the surgeons that I work with, they use the Mayo as a free standing Mayo, so they're just grabbing for themselves. So I have everything that they need and ready on the Mayo. So I go ahead and put a scissor and a suction. Could I wait and put those up there after? Yes, totally. But I just have everything ready. Some surgeons don't use a clip applier. They use the ties. Again, that's surgeon preference. So go ahead and do what your surgeon wants.

CHAPTER 3

And I'm gonna get a roll towel for my instruments. And then get ready to count. And I just hide this underneath the pan if I can. And grab my needle driver so I can load my knife. And I always touch all my instruments to make sure what I have. It's just a habit of mine so that I know what I have in my pan if we open. I also put all of my tooth forceps together and my non-tooth forceps together so I don't mix them up throughout the case. I put a scissor on my Mayo in case the drape does not fit the patient, and you need to adapt the drape to the patient. Now I can go ahead and start putting stuff on my Mayo. Actually, before I do that, I'm gonna go ahead and grab the instruments, the laparoscopic instruments that I need. In general, our surgeons that I work with use a hook, so I can just go ahead and put that on my Mayo. Or I can have it sitting to the side. It's a smaller Mayo, I can have to the side. I have a Maryland for dissection, Make sure it's movable and working. Then we have a grasper that can lock. And then we have another grasper that we can just grab other tissue with, that is not locking. Okay, then I can go ahead and put my drapes on top of there. Get my area set up here. I'll go ahead and grab all of my trocars that I threw into my basin and put them on my Mayo 'cause that way I'm ready at the beginning of the case. Some surgeons like a Veress needle, so I would put that on my Mayo as well. They'll start with that, and then have a syringe full of saline. I'll keep my suction, in case we convert to open. Along with my tip, just have it here. And I'll grab my cord and put that hook on it. Cord for my monopolar, and that is ready to be thrown. I can put that there and then put my light handles up there and I'm ready to count.

CHAPTER 4

Actually, let me load my blade real quick. I've always been taught that you load your blade and be ready in case something happened while the patient rolls in the room.

CHAPTER 5

Okay, Ray-Tec, my strip is off. One, two, three, four, five, six, seven, eight, nine and 10. Blades, there's one. Cautery tip, there's one. Needles, one and two. I'm gonna cut that needle off for my Carter-Thomasan. And, that should be all my sharps and smalls. And then I can count my instruments. Retractors, one, two, three, four, five, six, seven, eight, nine. Then I'll start with mosquitoes, one, two, three, four. Hemostats, one, two, three, four. Kellys, one, two, three, four. Peons, one, two. Let me move this outta the way. Tonsils, one, two. Allis, one, two, three, four. Babcocks, one, two. Kochers, one, two. Right angles, one and two. Sponge sticks, one, two. Needle drivers, one, two, and three. Towel clamps, one, two, three, and four. Scissors, one, two, three, and four. Knife handles, one, two, and three. Forceps, one, two, three, four, five, six, seven. Again, I'm gonna make sure that I have all of these instruments ready to put on the Mayo, and then I'm ready to start the case.