Setup for an Exploratory Laparotomy with Possible Splenectomy (Ivy Tech Community College, Indianapolis, IN)

Proper operating room setup for an exploratory laparotomy with possible splenectomy is critical for optimal surgical outcomes and patient safety. This educational video includes discussion of the proper draping sequence, warm irrigation, instrument organization, and preparation for the initial count with a circulator.

Exploratory laparotomy is a fundamental surgical procedure performed to investigate abdominal pathology when diagnostic uncertainty exists or when urgent surgical intervention is required. This procedure is commonly indicated in cases of abdominal trauma, acute abdominal pain of unknown etiology, suspected intra-abdominal hemorrhage, or when imaging studies are inconclusive.¹ The spleen is one of the most frequently injured organs in blunt abdominal trauma, accounting for approximately 25–30% of solid organ injuries.²

Splenectomy, whether emergent or elective, carries significant clinical implications. Although the spleen's role in immune function has led to increased efforts toward splenic preservation through splenorrhaphy or partial splenectomy when feasible, total splenectomy remains necessary in cases of severe trauma, uncontrolled hemorrhage, or extensive splenic damage.^3–5 The mortality rate for emergency splenectomy in trauma patients ranges from 5–15%, with outcomes heavily dependent on the severity of associated injuries, hemodynamic stability, and time to operative intervention. Postsplenectomy patients face lifelong increased risk of overwhelming postsplenectomy infection (OPSI), with an estimated lifetime risk of 3–5% and mortality rates approaching 50% when sepsis occurs.^6,7 These clinical considerations underscore the importance of operative preparation, as delays in setup can impact patient outcomes in time-sensitive emergency laparotomy situations.⁸

To protect the patient from developing perioperative hypothermia, warm irrigation fluid may be needed. A fluid warmer and sterile drape should be in the operating room. All fluids accepted onto the sterile field must be properly labeled (name, strength/dose, expiration date) to prevent errors.

A straddle instrument table is often used as a back table for this procedure. Square and shorter than most back tables, it allows access to all areas from a single position, maximizing efficiency. A towel may be placed beneath the surgical instruments to prevent sharp tips from penetrating the drape. Patient drapes are positioned on the Mayo stand in sequence of application.

A sharps container is positioned in the bottom left corner of the back table and secured with adhesive backing. Scissors are placed adjacent to the sharps container for convenient access. The abdominal closing device (“fish”) is identified and positioned appropriately, as this countable item must be tracked throughout the procedure.

Two Asepto bulb syringes are present to assist with irrigation. A Yankauer suction tip is attached to the suction tubing, and a Poole suction tip is also kept on the table as the surgeon may switch to the Poole once the abdominal cavity has been entered.

The initial count with the circulator begins with soft goods and sharps, including electrocautery tips, suture, a Penrose drain, and vessel loops. Several laparotomy sponges are moistened and placed in the fluid warmer.

Forceps are arranged along the side of the instrument pan: toothed (sharp) on one side, smooth on the other. This separation prevents inadvertent use of toothed forceps on delicate structures. A long knife handle is used during the count to separate the instruments, which minimizes risk of injury to the surgical technologist and makes it easier for the circulator to see the tip of each item as it is being counted.

The pieces of the abdominal retractor set (in this case, a Bookwalter), must be counted according to institutional protocols, as facilities may vary in methodology. The retractor set in this video includes a large oval ring, a segmental ring, and many attachments.

This demonstration aims to provide an educational resource for surgical technology students and practitioners, and others interested in learning about efficient operating room setups.

Nothing to disclose.