Setup for a Laparoscopic Appendectomy (Eastwick College, Ramsey, NJ)

Laparoscopic appendectomy has become the standard surgical approach for acute appendicitis. Organization and maintenance of the sterile field are necessary in order to protect the patient’s safety and ensure an efficient surgical workflow. This educational video demonstrates how to prepare a back table, Mayo stand, and ring basin for a laparoscopic appendectomy using an efficient method that promotes patient safety.

The surgical treatment of acute appendicitis was significantly improved with the introduction of the laparoscopic appendectomy, first performed in the early 1980s.¹ Advantages of the laparoscopic approach compared to open surgery include less postoperative discomfort, shorter hospitalization stays, quicker postoperative recovery, and greater satisfaction with the appearance of the surgical site after surgery.^2,3 The surgical technologist plays an important role by creating and maintaining the sterile field, preparing instruments and supplies, assisting the surgical team, and performing surgical counts with the circulator.

The setup protocol demonstrated here begins with establishing the sterile field by draping the back table and Mayo stand. A ring basin is used to organize supplemental items, including a bulb syringe, skin prep applicator, light handle cover, surgical gowns, gloves, drapes, and towels. Before any fluids such as medications or saline may be introduced onto the sterile field, they must be verified with a circulator (name, concentration, and expiration date) and each basin, cup, bulb, or syringe must be labeled appropriately.

Before the contents of any sterile tray may be placed onto a sterile field, each container must be inspected by the circulator and surgical technologist to verify that the container passed successfully through a sterilization cycle and there are no signs of moisture or strike-through contamination. This process includes verification of the internal chemical indicator and visual inspection of filters.

Once all items have been safely transferred onto the sterile field, the surgical technologist organizes items by category: forceps, retractors, instruments on the stringer, laparoscopic instruments, cameras and scopes, as well as soft goods and sharps. Items that will be used at the start of the procedure are placed on or near the Mayo stand.

Together, the circulator and the surgical technologist perform the initial count. Items to be counted include all sponges, sharps, instruments, marking pen, and ruler.

Items needed at the start of the procedure are placed onto the Mayo stand: various cords (for the camera, light, insufflation tubing, and cautery cord) that will be handed off to the circulator, a skin marker for the surgeon to mark port locations, medication containers and a syringe for local anesthetics, a scalpel, and assorted clamps, trocars, a Veress needle for insufflation, and radiopaque sponges.

This video aims to promote skill standardization, consistency in teaching, and aid visual learning of complex spatial organization. Laparoscopic procedures are extremely common, so surgical technologists must know how to set up for such surgeries quickly and efficiently.

Nothing to disclose.