Setup for an Open Cholecystectomy (Eastwick College, Ramsey, NJ)

The success of all surgical procedures depends, in part, on adherence to sterile technique and well-ordered arrangement of instruments and other items to support optimal efficiency. This educational video demonstrates a complete back table and Mayo stand setup for an open cholecystectomy, including preparation of the sterile field and organization of instruments and supplies in order to prepare for the initial surgical count with a circulator. Educational materials, such as this video, that provide guidance on proper setup methods, can benefit surgical technology students and new practitioners by encouraging them to create consistent perioperative practices.

An open cholecystectomy is a commonly performed general surgery procedure in which the gallbladder is removed by way of an abdominal incision. Although laparoscopic cholecystectomy has become the standard method of gallbladder removal due to its minimally invasive nature and quicker recovery time, open cholecystectomy remains an essential option for specific cases, such as severe inflammation, complex anatomical structures, or failed laparoscopic attempts.^1–4

The surgical technologist’s responsibilities include opening the sterile field, arranging all required surgical instrumentation and supplies, performing the initial surgical count with the circulator, and assisting the surgeon and others throughout the surgery. Implementation of a standardized setup helps to reduce surgical delays and minimize contamination risks. In this educational video, the Mayo stand, back table, and double ring stand had been draped in a sterile manner, and the circulator checked the condition of each instrument container to assure sterility had not been compromised. The surgical technologist then arranged the instruments, sponges, and sharps to prepare for the initial surgical count and facilitate optimal flow for the surgical team.

The circulator confirmed the name, strength, and expiration dates of medication and saline with the surgical technologist before it was accepted onto the sterile field and all containers for these items were labeled accordingly. Sterile gowns, gloves, and towels were prepared for the surgeon and assistant. Patient drapes were arranged in order of use, with additional gloves, skin preparation solution, light handle covers, suction tubing, and extra towels positioned for ready access.

Inadvertently leaving a sponge, needle, or instrument in a patient is a rare but serious surgical error. Such errors, called retained surgical objects (RSOs), can lead to severe complications such as infection, the need for another surgery, and even death.⁵ For this reason, an initial surgical count is performed to get a baseline count for all goods such as sponges, sharp items (needles, hypodermic syringes, scalpels), and surgical instruments. This count is repeated when closing a body cavity, and before the final skin closure to minimize the risk of any retained objects.

Instruments on the back table were arranged according to their functional categories. Traumatic (toothed) forceps were separated from smooth (atraumatic) forceps. Knife handles were placed in the safety zone. The initial instrument count was completed with the circulating nurse, who tracked and recorded everything on the count sheet. Following this, instruments needed at the start of the procedure were placed on the Mayo stand to provide the surgical team with quick access.

Educational videos such as this one serve as important resources for surgical technology education programs. These materials can help surgical technologists contribute to the patient’s safety throughout the surgical procedure by improving their skills.

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