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Vascular and Intestinal Anastomotic Workshop. PGY 1. Name the Instruments. PGY 1. Name the Instruments. PGY 1. Name the Instruments. PGY 1. Commonly used Sutures. PGY 2. Lembert Sutures. Definition? Reason?. PGY 2. Connell Sutures. Describe Connell suturing technique. Staplers.

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Presentation Transcript
lembert sutures

PGY 2

Lembert Sutures
  • Definition?
  • Reason?
connell sutures

PGY 2

Connell Sutures
  • Describe Connell suturing technique
side to side anastomosis

PGY 2

Side to side anastomosis
  • How do you set up a side to side anastomosis?
  • CRITICAL CONCEPTS
  • Non-tension
  • GIA stapler
  • Align anti-mesenteric sides of bowel together
  • Staggered staple lines
end to end a nastomosis

PGY 2

End-to-end Anastomosis
  • How do you set up a stapled end-to-end anastomosis?
functional end to end anastomosis

PGY 2

Functional End-to-end anastomosis
  • Describe another way to perform a stapled end to end anastoamosis
stapler loads

PGY 3

Stapler Loads
  • What is the difference between the different stapler loads?
  • What color load do you use for vascular tissue? Stomach? Small bowel? Colon? Rectum?
hand sewn anastomosis

PGY 3

Hand Sewn Anastomosis
  • Describe the different types of suture techniques used in hand sewn bowel anastomosis
hand sewn anastomosis1

PGY 3

Hand Sewn Anastomosis
  • Describe the steps for a 2 layer anastomosis
hand sewn anastomosis2

PGY 3

Hand Sewn Anastomosis
  • Describe how to sew a single layer anastamosis
arm vascular anatomy

PGY 2

Arm Vascular Anatomy
  • Describe the arterial and venous blood flow to the arm
types of surgical dialysis access

PGY 2

Types of Surgical Dialysis Access
  • What is the difference between an AV Fistulae and an AV Graft
dril procedure
DRIL procedure
  • DRIL = Distal Revascularization Interval Ligation
  • RUDI = Revision Using Distal Inflow
vascular anastomosis

PGY 3

Vascular Anastomosis
  • Identify autogenous materials for vascular anastomosis:
    • Saphenous vein, iliac vein
  • Identify exogenous materials for vascular anastomosis:
    • bovine pericardium, ePTFE, gore-tex, cadaveric
  • What is the dosing/timing for heparinization during a vascular anastomosis?
    • 75-100 units/kg, given 5 minutes prior to vascular occlusion
  • How do you measure heparinization to confirm appropriate levels have been achieved?
    • Activated clotting time (ACT) of greater than 250
zones of retroperitoneum

PGY 3

Zones of Retroperitoneum
  • Describe the Zones of the retroperitoneum and the major vasculature that could be injured in each zone
  • Zone 1: Midline retroperitoneum
    • Supramesocolic region (suprarenal aorta, celiac, SMA/SMV, proximal renal artery)
    • Inframesocolic region (infrarenal aorta, infrarenal IVC)
  • Zone 2: Upper lateral retroperitoneum (renal artery/vein)
  • Zone 3: Pelvic retroperitoneum (iliac artery/vein)
zone i great vessel injury

PGY 3

Zone I Great Vessel Injury
  • Describe the approach for supramesocolic Zone I injuries:
    • Left medial visceral mobilization
    • May also need to transect the left crus (at 2o’clock position) to allow for control of the descending thoracic aorta
zone i great vessel injury1

PGY 3

Zone I Great Vessel Injury
  • Describe the approach for inframesocolic Zone I injuries:
    • Lift up on transverse mesocolon, eviscerate small bowel to right, open mid-line retroperitoneumand cross clamp the aorta inferior to the left renal vein
    • For IVC injuries, perform a right medial visceral mobilization (right colon and duodenum), leaving the kidney in situ
zone i great vessel injury2

PGY 3

Zone I Great Vessel Injury
  • Describe the approach to an inframesocolic Zone I injury to the IVC at the common iliac vein confluence:
    • After right medial visceral mobilization, it may be necessary to divide and ligate the right internal iliac artery or to temporarily divide the right common iliac artery
zone i great vessel injury3

PGY 3

Zone I Great Vessel Injury
  • Describe the approach to an inframesocolic Zone I injury to the IVC at the level of the renal veins:
    • After right medial visceral mobilization, you should clamp/compress the IVC proximally and distally and loop/clamp both the left and right renal veins. It may be necessary to perform a medial mobilization of the right kidney (watch out for 1st lumbar vein!)