General Surgery

Exploratory LaparotomyGeneral Surgery

LaparotomyLaparotomyan incision made through the abdominal wall to perform an operation on the abdominal contentsOnce the abdomen is opened, a particular procedure can be initiated depending on the specific conditions that are discovered.2Laparotomyan incision made through the abdominal wall to perform an operation on the abdominal contentsExploratory laparotomya laparotomy performed as a diagnostic procedure, when the exact nature of the patient's condition or disease is unknown Once the abdomen is opened, a particular procedure can be initiated depending on the specific conditions that are discovered.Notes on preoperative preparationMost facilities have a generic Ex Lap preference card Unless you know the specifics of the procedure, only open what you need to start the caseIn emergent Ex Laps the most important components to start will usually be a knife, suction, laps, and retractionA full instrument count will always be performed

Positioning, Prepping, and DrapingUnless the surgery involves the lower portion of the sigmoid colon or rectum, the position will usually be supine. Always place a pillow behind the kneesArms may be on an armboard or tucked depending on surgeons preferencePrep from nipples to midthighWarming blanket over legs or armsSCDsFoot drape, Squared towels, Laparotomy DrapeLaparotomy-Surgical TechniqueProcedureInstrumentation and InterventionSkin Incision is made and carried to the fascia#3 Handle/#10 BladeBovieLapsHemostasisCautery, Hemoclips, or Hemostats, Debakey Forceps, SuctionRetraction of wound edgesRichardson-Eastman or Self Retaining RetractorExternal Fascia is DividedMetzenbaum or Scalpel, ForcepsPeritoneum is exposed and incisedMetzenbaum Scissors, Kelly HemostatsRetraction of body wallKochers or Richardson Ret, Suction, Laps, possible placement of Retractor SystemBegin ExplorationNotes for Intraoperative techniquesRaytex should never be utilized unless on a sponge stickToothed forceps should not be used past the subcutaneous layerIf laps or towels are placed in the wound, it is the Scrub technicians responsibility to know where and how manyKeep the field clean; remove blood soaked laps, remove instruments from patients lap, ensure bovie tip is cleanPay attention to field depth; as the case progresses transition to appropriate length instruments, bovie tip, etc.On to other proceduresOnce the abdomen is opened, hemostatic control is accomplished , and retractors are placed, any number of procedures may be performedLysis of adhesionsBowel resectionProcedures on the stomach, pancreas, liver, or spleen

Exposure and retraction techniques will vary with incision typeOther procedures..Defining and determining gastrointestinal procedures from our point of view requires;Understanding of medical terminologyUnderstanding of anatomyKnowledge of basic surgical techniquesKnowledge of modalities and instrumentationMost basic techniques for resection of structures the GI tract are essentially the same