Setup for an Open Pancreatectomy (Kingsborough Community College, Brooklyn, NY)

Open pancreatectomy is a complex abdominal procedure requiring detailed preoperative preparation by the surgical technologist. An efficient sterile back table and Mayo stand setup is important for patient safety and operative workflow. In this educational video, the setup sequence demonstrates sterility verification, instrument organization, the initial surgical count, and medication labeling. All steps were conducted in accordance with perioperative safety standards.

Open pancreatectomy, including the Whipple procedure (pancreaticoduodenectomy) or distal pancreatectomy, is arguably one of the most difficult and technically demanding surgical procedures performed today.^1,2 It is indicated for pancreatic malignancies, chronic pancreatitis, and pancreatic trauma, and it demands a highly coordinated surgical team. The surgical technologist must provide an efficient sterile setup and work with the circulating nurse to obtain accurate surgical counts and properly handle fluids and medications on the sterile field. Any errors can contribute to adverse patient outcomes. Studies mandate that surgical counts be performed in a defined sequence: soft goods, sharps, and instruments prior to every procedure (to obtain a baseline), before closing a cavity/organ, and before wound closure.³ Studies have demonstrated that retained surgical items (RSIs) remain a preventable sentinel event, with estimates suggesting one RSI occurs per 5,500–7,000 surgeries in the United States.^4,5

This educational video aims to provide students and others with standardized, observable models of best practice before entering clinical environments.

All preparations are done prior to entry of the surgical team and include verifying that each instrument container is free of contamination, as well as setting up the back table, Mayo stand, and ring stand. On the back table, a rolled towel is prepared to hold the instrument stringer. Forceps are separated and organized by type to ensure appropriate selection during tissue handling and to prevent inadvertent injury to delicate ductal or vascular structures.

The Mayo stand is stocked with items required at the start of the case: light handle covers, suction tubing, and the electrosurgical (Bovie) unit. Knife handles are loaded with blades using a needle holder. A number 10 blade is mounted on a number 3 handle for initial incision, and a number 15 blade is prepared for finer dissection.

The initial surgical count is performed with a circulating nurse in the standard sequence: soft goods (sponges), sharps, and then instruments. Typical instruments for this procedure include hemostatic clamps, tissue clamps, vascular instruments, needle holders, scissors, suction devices, retractors, forceps, and a self-retaining retractor counted in component pieces.

On the sterile field, medications must be verified for name, strength/concentration, and expiration date and each of those must be confirmed with the circulating nurse. In this case, 1% lidocaine with epinephrine was verified, including the expiration date. A label which included all of that information was placed on the syringe.  

Sterile gowns and gloves were prepared for all members of the surgical team. Drapes were arranged on the Mayo stand in the sequence in which they will be used to ensure smooth and uninterrupted patient preparation.

Resources such as this provide useful learning information for students of surgical technology, faculty in allied health programs, and for educators in the perioperative setting.

Nothing to disclose.