Setup for an Open Total Thyroidectomy (Ivy Tech Community College, Indianapolis, IN)

CHAPTER 1

Hi, I'm Dave Wiseman, I'm the Clinical Coordinator for the Surgical Technology department at Ivy Tech Community College in Indianapolis. And today, I'm gonna talk to you about setting up your back table and having your supplies ready for an open total thyroidectomy.

CHAPTER 2

Fortunately, for a thyroidectomy, you don't have a lot of instrumentation, so typically, one pan and assuming the thyroid itself is being removed suprasternally and you don't have to open up the sternum, you don't have to count instruments either. So a lot of people like thyroids 'cause you don't have to count instruments. I am going to place a couple of towels here. I put one towel underneath my instrument pan, I put one towel underneath where I'm gonna put all my sharps. I like to have just a little extra layer of protection. I know a lot of facilities now have the back table packs that have a built-in towel or that extra layer. So if you have that, maybe you don't need it already. Drape-wise, pretty simple for a thyroid. So we're gonna have a down sheet to put down first. Four towels to towel out the incision site and then a split sheet. And so I'm gonna go ahead and place those on my Mayo, they're all ready to go for the beginning of the case.

CHAPTER 3

I've got gown and gloves for both my surgeon and the assistant. Typically, you need an assistant with the thyroid. If you don't have an assistant, it's just you and a surgeon, just be prepared to be holding retractors while you're passing instrumentation. A lot of the rest of the setup is pretty typical. I have a little trash can. I'm gonna place right down here for any loose suture or anything.

CHAPTER 4

Go ahead and make my roll towel for my instrumentation. Get it as firm as possible. And for a visual presence here, we're gonna put our stringer on the table facing you, so you can see whatever instruments we might be using here. I like to place my stringer underneath the instrument pan just so it's not part of the surgery and nobody sees it again. Then when I'm placing my forceps, I put 'em on the side of the pan. I like to separate my toothed instruments from the smooth instruments. And the way I do so is I use the big Joe 'cause it's very easy to recognize, also, Ferris-Smith. I put that right in the middle, put all my smooth in front of it and all my toothed behind it. And then that way, at a quick moment's glance, I can tell whether I'm grabbing a smooth instrument or something with teeth.

CHAPTER 5

I'm going to take all of my sharps that I have on the table and move those over to the sharps box to keep everything nice and safe. These are some supplies that I passed at the beginning of the case. So you do have some different supplies that you'll need for a thyroidectomy, not the least of which is a bipolar forceps. So in addition to your normal monopolar Bovie, you're gonna need bipolar energy. The reason for that is you have a lot of nerves and a lot of small vessels in this area, and you need to be much more precise, and your bipolar forceps is gonna give you that level of precision that the monopolar is not gonna provide.

CHAPTER 6

Another item that is super important are Ligaclip appliers. So some surgeons might use silk ties, some might use your standard manual load Ligaclips with the cartridges. These are automatic Ligaclip appliers that come preloaded with 20 clips, and you can hand it to the surgeon, and they can clip, clip, clip away. So we have a small and a medium size for that and we'll have those ready. A lot of times you'll go through four or five, maybe five or six of these during a case.

CHAPTER 7

Being that there's a lot of nerves in that area, you're also gonna want to be able to identify those nerves. So this is a handheld nerve stimulator. There are prass probes for Medtronic's NIM monitors. There's a lot of different nerve monitor options out there, just know that you'll be using some type of nerve monitoring or some type of nerve identification most likely.

CHAPTER 8

This supply here is used to help hold the wound open. These are called fish hooks. They are very sharp, oftentimes, they do make a blunt version of it, so you just want to make sure you know whether you have a sharp or a blunt one. But it is a very sharp hook with a long elastic cord, and it is used for self-retaining retraction during the case. So the way you load these is you'd simply place a hemostat or a mosquito right at the back so that they're ready to place it. And I preload mine, so I would just take however many I think they're gonna use, four or five, and I would go ahead and have those all loaded on the hemostats so they're ready to pass, and I keep 'em over here with my other sharps.

CHAPTER 9

At this point, I would be ready to count with my circulator. I do have a flexible suction tubing that I'm gonna use. I'll attach that to my normal length of suction tubing. This just provides a little bit of flexibility at the site, so the surgeon's hand is a little more comfortable.

CHAPTER 10

My circulator is all ready to count with me, so I'm gonna go ahead and get my lap sponges out. I've got everything situated to be counted, all kind of right in front of me, so I'm gonna count my laps first. And I have one, two, three, four, five. One, two, three, four, five, for 10 laps. And I have Kittners or peanuts. One, two, three, four, five. I have a Bovie scratch pad for one. I have Bovie tips. I have one regular tip and then I have one extended tip. This is also a guarded tip. You're typically gonna use either a normal length guarded tip or one that's long like this. My surgeon prefers an extended length, but the guarded insulated portion of the tip protects any nerves or any vessels that are close by to the area that they're Bovieing. Blades, I have one, two. And suture, I have one eight pack, one, two, three, four, five, six, seven, eight. And this is a 4-0 Monocryl. Typically, you're gonna use a 3-0 Vicryl. And you may use as many as 200 on one of these cases, it just depends.

CHAPTER 11

The only other thing that we have here is we need to move some of these out of the way and get some irrigation on our field. Anytime you're working above the shoulders, you have a potential for an airway fire. So you always wanna make sure you have saline water on the field, something to prevent a fire. And at this point, I think I'm ready for my surgeon to come in and start the case.