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

CHAPTER 1

Hi, my name is Hansel Perez. I'm a surgical technologist. Today we're at Eastwood College and I'm going to be going over how I set up for a laparoscopic appendectomy.

CHAPTER 2

To start off coming up to my field, I'm gonna make sure my sharps are secured. So far, I have my back table draped. I have my Mayo stand double draped with towels. I also have some additional supplies here.

CHAPTER 3

On my ring basin, I have a bulb syringe, a skin prep stick, and a light handle cover, as well as towels, gowns, and gloves for the surgeon and the resident. And I have drapes and four towels to square off the surgical site.

CHAPTER 4

Here, I have medication that me and my circulator acquired. I have lidocaine 1% and Marcaine 0.25%. When we pulled this, we made sure we went over the name of the medication, the strength, and the expiration, and appropriately labeled the syringe and the medicine cup.

CHAPTER 5

Now I'm ready for my circulator to grab my instrument trays. This is my circulator for the day, Aliany Villalona. I'm gonna start with the cords and scopes. I'm gonna have her check the filters and the lid of the tray to ensure sterility before I grab anything. No moisture, no strike-through. No moisture, no strike-through. No moisture, no strike-through. No moisture, no strike-through. Now I'm gonna grab the chemical indicator strips inside the tray. I'm gonna make sure they're all good. All good. All good. Then I'm gonna hand these off, get confirmation from her that they're okay. All right, now I'm all set to grab the tray and I'm gonna wait for her to check the filters on the bottom of the tray. No moisture, no strike-through. No moisture, no strike-through. No moisture, no strike-through. No moisture, no strike-through. All right. Now, I'm all set to put this on my back table. For this one, I'm only gonna wanna grab what I need. So to start off, I'm gonna put these on my Mayo stand in order that they're gonna be given out. So for the cords, I have a light cord. That's gonna go first. That's gonna be followed by the camera cord, the insufflation tubing, and finally, the cautery cord. Next, I'm gonna grab my scopes. I have a zero-degree scope. This is gonna be for a more broad view of the entire surgical site. I also have a 45-degree scope, which is gonna be used for a more focused view on the anatomy that you're doing the procedure on. The preference card is gonna tell you what the surgeon prefers for that specific case. I'm also going to grab a Veress needle for insufflation. So now that I have everything that I need from this tray, I'm going to hand this back off to my circulator. There you go. Thank you, and I'm going to receive my instrument tray. Now, same thing for this tray, I'm gonna wait for her to check the filters on the lid. No moisture, no strike-through. No moisture, no strike-through. No moisture, no strike-through. No moisture, no strike-through. I'm gonna grab the chemical indicator, and make sure it's all good. Wait for confirmation. Okay, gonna hand off the count sheet. And I'm gonna wait for her to check the filters on the bottom again. No moisture, no strike-through. No moisture, no strike-through. No moisture, no strike-through. No moisture, no strike-through. All right, I'm all set to put this on the back table. I'm gonna take all of my instruments out of here. I like to lift the mat up, and make sure there's no instruments being left behind in here. And then these can go back inside. I'm gonna organize everything here. I have a towel roll for my stringer. I'm gonna put this on here. And my retractors on here. And my forceps. I'm gonna organize them for traumatic on this side and atraumatic on the other side. So before you begin your initial count, you just wanna take a look, make sure you have everything you need. Everything looks good.

CHAPTER 6

So I'm gonna ask my circulator if she's ready to do the initial count. Okay, so we're gonna start with our soft sponges. I have laps. 1, 2, 3, 4, 5. Ray-Tecs. 1, 2, 3, 4, 5, 6, 7, 8, 9, 10. I have my sharps. I have blades, 1. Sutures, 1, 2. Hypodermic needles, 1. Trocars. Trocars, how they count vary from facility to facility. Here, we just count them as individual pieces. So I have a 12-millimeter blunt trocar, which is used mainly for the scope. 1, 2. And then I have a five-millimeter trocar. This is what the surgeon is gonna stick the instruments through. 3, 4. 5, 6. And I have Veress needle, 1. I'm gonna move on to my laparoscopic instruments. I have biopsy cup, 1. Allis, 1, 2. Maryland dissector, 1. Maryland grasper, 1, 2, 3, 4. I have Babcock, 1, 2. Alligator, 1, 2. And a laparoscopic needle holder, 1. Gonna move on to my stringer. I have Backhaus towel clamps, 1, 2. Criles, 1, 2. Kellys, 1, 2. Kochers, 1, 2. Allis, 1, 2. Babcock, 1, 2. Needle holder, 1. Straight Mayo, 1. Metzenbaum scissors, 1. Ring forceps, 1, 2. I'm gonna move on to my retractors. I have Army-Navys, 1, 2. McBurney Greens, 1, 2. And Senn, 1. Moving on to my forceps, I have traumatic on this side. I have pickups with teeth, 1, 2. I have Geralds, 1, 2. And I have Adsons with teeth, 1, 2. Onto my atraumatic forceps side, I have non-toothed pickups or plane pickups, 1, 2. And I have one #7 knife handle, markers, 1, 2, and ruler, 1. I'm gonna confirm that my initial count is complete with my circulator. Count complete. Now I'm gonna get ready to set everything up for the procedure and for the patient.

CHAPTER 7

Once the patient is draped and the surgeon is ready to begin the procedure, I'm going to roll my Mayo stand over. We're gonna throw these cords off to the circulator so they can plug it into the laparoscopic tower. And then I will show you how I set my Mayo up for the beginning of the procedure. We're gonna start with a skin marker. Surgeon's gonna mark the site off before anything. Then we're gonna have our medication on the field. Then I'm going to load my 11 blade onto my 7 knife handle. This is going to be used to make the puncture wound to insert the trocars. When you're loading these blades, just, you know, sharp safety, make sure you're doing it over the sharp box. That's gonna go here. I'm gonna have two Kochers for the surgeon to hold the skin while he's inserting the trocars, followed by the Veress needle, and my three trocars. Now, these are gonna be in order. You're going to have skin marker, lidocaine, Kochers, Veress needle, and your trocars. And I'm also going to put two Ray-Tecs on my Mayo stand. It's good to have some sponges on your Mayo because these puncture wounds that we're making to insert the trocars tend to bleed a little bit. So it's good to have those up there. Once you have that on your Mayo stand, you're all ready for the timeout and procedure to begin.