OR Setup for an Open Incisional Hernia Repair with Mesh (South College, Knoxville, TN)

CHAPTER 1

Hi guys. My name is Shannon Morris. I am a clinical coordinator for the surgical technology program here at South College at the Knoxville campus. And today I'm gonna show you a setup for a basic incisional hernia repair. So before we get started with that, there were some crucial steps that were completed leading up to this. So I made sure I checked my surgeon's preference card. I gathered all my supplies. I opened all of my supplies after checking the integrity of them. I also opened my tray, and I can see that my indicator's in there and it is black. I also double draped my back table and I've already double draped my Mayo stand as well.

CHAPTER 2

Now that we've opened up everything and we're ready for setup, I'm gonna grab my tray first, but before I can grab it, I also have to double verify with my circulator. So I'll pick my tray up. My circulator's gonna check inside of my tray before I set it down to make sure there's no moisture. And she's confirmed with me that everything is good. Now, with your back table, I always wanna determine which side is my working end and which side is my non-working end. For today, the left side will be my working end, and then the right side will be my non-working end. On my non-working end, I'm gonna put supplies, such as my towels, my surgeon's gowns, the assistant's gown, and my drapes. One thing I like to do for my surgeon and the assistant's gloves is I like to stack them inside of each other just so that way when they open it up, it'll be like a book. Indicator glove is on top, the Biogel is on the bottom. So I'll put those under the gowns. I always like my back table and my Mayo stand to mirror the order that everything's gonna go. So my surgeon and my assistant will come in. I will gown and I'll glove them, and then we will do draping.

CHAPTER 3

Next, I'm gonna take everything out of my ring basin and I'm gonna add it onto my back table. So here I have my Ray-Tecs. And my laps. I will put all of those on my working end. My softs and my sharps will go on this side. I also have my basin here for saline. I also have another bucket here, and I have a kidney basin. I'm also gonna add a towel over here for a no-pass zone. This is just to put all my sharps on so everyone will know where my sharps are at. I'm also gonna get out my sharps box. I have two blades already in here ready for me to load on my knife handle. My marking pen, medicine cups. And I also have my mesh. This is very, very important to always keep this clean. Do not let any fluid, any blood, or anything get on this. This is going to go inside the patient. One thing I like to do, just to give it an extra layer of protection is I like to wrap it up in a towel. And I'll tuck it underneath my tray. I'm also gonna leave my Bovie tip, my light handle, and my suction tubing in here. Once the patient has come in and we've draped the patient out, I will move this up to the patient's feet. So I'll have all this to throw off to my circulator.

CHAPTER 4

Next, I'm gonna make my roll towel, so I can lay all of my instruments out, and I'll organize my tray. This will make it easier and efficient for my counts. Now I'm gonna organize all of my forceps and my retractors inside my tray. Now, for my forceps, I like to separate these from atraumatic and traumatic. I put all of my atraumatics on my working end and I put my traumatics on my non-working end. I'm gonna put my knife handle on my sharps box, so that way I can load them with my needle driver.

CHAPTER 5

All right, next, I'm ready for a count. I will call my circulator over at this point for my initial count. So first, to count, we always start with our softs. I never pop the seal on my softs until I'm ready to count. So I'll start with laps. I'll give those a little fan just to separate 'em and make it easier. Laps, I have one, two, three, four, five. Ray-Tecs. I have one, two, three, four, five, six, seven, eight, nine, 10. Now, for my sharps, I'm gonna use my knife handle to point so that way I don't touch the sharps and risk cutting myself. So blades, I have one, two. Needles, I have one, two, three, and four. I have one Bovie tip. And that's all for my softs and my sharps. Next, I can move on to my instruments. I have one, two mosquitoes. One, two, three, four hemostats. One, two, Kelly. One, two, three, four Allises. One, two Kochers. One, two, three, four Babcocks. One, two tonsil Schnidts. I have one right angle. One, two, sponge stick. One, two, three, four needle drivers, One Metzenbaum, one curved Mayo, and one straight Mayo. Next is retractors. I have one double-ended Rich, one Army-Navy, one Gelpi, one Weitlaner, one Rake. Always check your Senns 'cause you could have one sharp and one dull. I also have towel clips. I have one non-penetrating. I have one, two, three, and four penetrating towel clamps. I also have a Yankauer suction that is one and two pieces. My forceps, I have one smooth pickup, one DeBakey, one rat tooth, one Adson with teeth for a total of one, two, three, four forceps. Knife handles, I have one, two. And that would be all for my counts.

CHAPTER 6

Next, I can move on to adding all of this instrumentation onto my Mayo stand that I'll need for the operation. So I'm gonna go ahead and unstring my instruments. For my stringer, I always like to put it under my tray as well. This is just so I can make sure it doesn't fall off and I don't lose it at the end of the case 'cause I will need it later. So first, I'm gonna load my blade. I'm gonna use a needle holder to load my blade. I have a number three and I'm gonna load a 15 blade. Now for my blade, I'm gonna move that over to my Mayo stand. I'm gonna add another blue towel here and this will just represent my no-pass zone. So once the surgeon's done, if I'm busy moving on to the next step, he or she can sit that blade back there and let us know that it's there. All right, next I'm gonna add two mosquitoes. This is just for those little small vessels when we're getting in. I'm also gonna add two hemostats as well. Those are for the larger vessels. And to help dissect down. Next, I'll do two Allises. Next, I'm gonna add a sponge stick, and I'm actually gonna load it with Ray-Tec. This will just help during the procedure in case we need to blot for visualization. And the way we load our sponge sticks, we do a method that we call the diaper method and it just wraps the Ray-Tec all the way around, 360. I'll set that right there. I'm also gonna add my Metzenbaum scissors. This is for delicate tissue dissection. I'm also gonna add my curved Mayos. This is more for thicker tissue, like your fascia. And then always, always, always have your Mayo suture scissors. You will need those. I'm gonna add a Weitlaner up there for retraction after incision. This is a self-retaining retractor. I'm also gonna add a pair of atraumatic pickups, so I'll use my smooths, and a pair of traumatic forceps as well. I'm also gonna put a couple of sponges up there 'cause we know we'll always need these.

CHAPTER 7

And then I'm going to keep my mesh on my back table until my surgeon asks for it. Sometimes your mesh, your surgeon may want you to cut it a little bit, trim it, and that's perfectly fine. Just always remember that when you're passing off your mesh, you always use an atraumatic forcep to hand it to the surgeon. Once my circulator has filled my basin with normal saline, I'm gonna make sure that I label it so everyone knows what this is. Once I have my normal saline labeled, I'm gonna add a couple of laps into it just to make sure that I have some moist laps because we are gonna be around the bowel and you always wanna make sure that you have those.

CHAPTER 8

So just to recap, this is a setup for an incisional hernia repair. This is your back table and what your Mayo's gonna look like. Thanks for watching, and I hope you learned something.