78

Surgicot Procedures lncluding Minirnol Access Procedures

Abdominol Extrointestinol Surgery

/p

Laparoscopes (2) (0", and 30o or 40') and cameras Exinrdable retractors (2) (fan, curved) Stone basket or 3-Prong grasper Stone-crushing forcePs Suction, irrigation, electrosurgical device

tween

camera.

5. and Z mm Hg), then higher flow according to surgeon's instructions. Connect and turn on light source and white balance

quested.

The circulator will turn on the VCR to record,

if re-

Supplies Foam padding for elbows, ankles Pneumatic antiembolitic stockings Guide wire (e.g., 0.035 mm) Fog reduction agent Loop sutures available (e'g., Endoloop) Cysio tubing (straight, f OoO-mL bag normal saline and 3-way stopcock) Electrosurgical cord Pressure bag t2 mL syringe, 3-way stopcock, K50 tubing

Cathetei, e.g., Taut, No. 5 ureteral catheter openended, Karlan

Culture tubes (aerobic, anaerobic) Video-cassette (oPtional) X-ray cassette on table, if image intensifier table not available Foley catheter Nasogastric tube (e.g., No. 16) Ligating clips Luer lock syringes, 35 mL (2) naaiopuq"" alv"" (e.g., Renographin 6O mixed half strength with normal saline) Blades (1) No. 10, (1) No. 15, or (1) No. 11" Suction tubing
Endoscopic specimen retrieval bag Ductal dilating balloon catheter (e.g., 7 Fr)

thorough cleansing. Use-an image intensifier table when possible; if not p_ossible, put cassette in a regular tableLhead oi ti-". Have a C-arm available. Some surgeons may retract the gallbladder with a toojhe_d grasper, which is then fastened to the drape. Cavitron unit may be requested for stone cr.rshin!. Iflaser is used, see pp. 619-624 for safety rules. Some surgeons use b000 U Heparin in i L of O.g% normal saline for irrigation: Turn room lights and overhead lights out dr.iring procedure; leav_e one light on overheaJfor .""rlb pe"Jor. Lights will be turned on again after the g"ilbl"dd". is out. Circulator should notify x-ray department regarding cholangiogram. Thescrub person covers the C-arm, if used, and cam_ eralolder. A drape covers the x-ray a.""ur,. ' cholangiogram.

The circulator rechecks position of monitors so that they can be easily viewed. The circulator connects all remaining items: irrigation-system, suction tubing, elebtrosurglcal cord. All. non-disposable instruments iray be flash_ sterilized. Soak scope and light cord in Steris solution after _

The circulator should turn off

th"

camu"a during

Skin closure strips

recorder.

Following the cholangiogram, the circulator reconnects the electrosurgical -device and turns on the
,

SpeciolNotes After the patient is in the room, position and connect

rnonitors. Position electrosurgical unit.

DNAINAGE OF PANCREATIC CYST

(PSEUDOCYST)

cu*"tu.ub-l", light cord, Silastic tubing, a-nd suction' The circulatoiadjusts insufflator. First 1ow flow (be-

f'ono*i"g clraping, the scrub person will pass off

Deflnition

Internal drainage ofa pseudocyst is performedby anastomosing the cyst wall to an adjaient hollow'viscus