Setup for an Exploratory Laparotomy with Possible Splenectomy (South College, Knoxville, TN)

The combination of an exploratory laparotomy with a possible splenectomy demands a quick and efficient back table and Mayo stand setup. This video demonstrates an efficient setup that includes placement of surgical instruments, sponges, hemostatic agents, and vascular clamps. The demonstrated setup techniques shown here provide surgical technologists with useful strategies to prepare for complex trauma cases.

For trauma surgeons, an exploratory laparotomy is a common surgical intervention, providing access to the abdominal cavity for suspected or confirmed internal injuries. The procedure demands urgent attention, particularly when splenectomy is likely indicated, or in cases of abdominal trauma resulting in hemorrhagic shock.^1,2

The spleen is a highly vascular organ located in the left upper quadrant, superior to the left kidney, making it particularly susceptible to both blunt and penetrating injuries. Time is a critical factor for patients experiencing active hemorrhage, and the technologist must rapidly establish the sterile field, anticipate the surgeon's needs, track instruments, track blood loss, and adapt to evolving intraoperative findings.

In this example, the back table was double draped and divided into three zones: the working end for sharps, sponges, and other supplies; the central area for surgical instrumentation; and the non-working end for gowns, gloves, and patient drapes.

The ring stand and stringer were prepared, and retractors were arranged in descending size order to facilitate gaining access to deep tissues. Forceps were organized by type (traumatic and atraumatic), with smooth (atraumatic) forceps placed at the working end to minimize risk of bowel injury, and sharp (traumatic) forceps positioned farther from this zone. Specialized vascular clamps were reserved for splenic artery and vein control.

An initial count of sponges, sharps, and instruments was conducted using a systematic verification process. Sutures were organized by purpose, including pop-off sutures for vessel ligation, 3-0 sutures for fascial closure, Vicryl for peritoneal layers, and large-gauge material for fascial reinforcement. Equipment for splenic hilar management was prepared with GIA stapler reloads, Ligaclips, hemoclips with their appliers, and presoaked vessel loops and umbilical tapes in saline solution.

The Mayo stand was arranged using the PRICKS mnemonic—Pickup, Retractor, Ink, Clamp, Knife, and Suction. A #10 scalpel blade was loaded onto a knife handle for the initial skin incision and positioned with its edge facing down for safety, and a second #10 scalpel blade was prepared for deeper dissection. Retractors, clamps, and suction devices were positioned for optimal accessibility. The blue towel folding technique to organize ties (which may be used to ligate blood vessels) creates distinct compartments within the towel for different tie sizes, enabling rapid access at the back table’s working end.

The setup presented here establishes a comprehensive and reproducible system for trauma surgery preparation and integrates theoretical principles with practical techniques. Institutions and practitioners can adapt these organizational methods for their own use. Dividing the table into distinct functional zones streamlines workflow and minimizes unnecessary movement during emergencies.

Students who observe systematic instructional videos may develop cognitive shortcuts that can reduce cognitive load and enhance performance during real surgical procedures. By observing experienced practitioners, students learn anticipatory thinking. Such educational tools can serve as valuable supplements in surgical technology curricula.

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