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General Surgery. Exploratory Laparotomy. Laparotomy. Laparotomy —an incision made through the abdominal wall to perform an operation on the abdominal contents Once the abdomen is opened, a particular procedure can be initiated depending on the specific conditions that are discovered.

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general surgery

General Surgery

Exploratory Laparotomy

laparotomy
Laparotomy
  • Laparotomy—an incision made through the abdominal wall to perform an operation on the abdominal contents
  • Once the abdomen is opened, a particular procedure can be initiated depending on the specific conditions that are discovered.
notes on preoperative preparation
Notes on preoperative preparation…
  • Most facilities have a generic “Ex Lap” preference card
  • Unless you know the specifics of the procedure, only open what you need to start the case
  • In emergent Ex Laps the most important components to start will usually be a knife, suction, laps, and retraction
  • A full instrument count will always be performed
positioning prepping and draping
Positioning, Prepping, and Draping
  • Unless the surgery involves the lower portion of the sigmoid colon or rectum, the position will usually be supine.
    • Always place a pillow behind the knees
    • Arms may be on an armboard or tucked depending on surgeon’s preference
  • Prep from nipples to midthigh
  • Warming blanket over legs or arms
  • SCDs
  • Foot drape, Squared towels, Laparotomy Drape
notes for intraoperative techniques
Notes for Intraoperative techniques
  • Raytex should never be utilized unless on a sponge stick
  • Toothed forceps should not be used past the subcutaneous layer
  • If laps or towels are placed in the wound, it is the Scrub technician’s responsibility to know where and how many
  • Keep the field clean; remove blood soaked laps, remove instruments from patients lap, ensure bovie tip is clean
  • Pay attention to field depth; as the case progresses transition to appropriate length instruments, bovie tip, etc.
on to other procedures
On to other procedures
  • Once the abdomen is opened, hemostatic control is accomplished , and retractors are placed, any number of procedures may be performed
    • Lysis of adhesions
    • Bowel resection
    • Procedures on the stomach, pancreas, liver, or spleen

Exposure and retraction techniques will vary with incision type

other procedures
Other procedures…..
  • Defining and determining gastrointestinal procedures from our point of view requires;
    • Understanding of medical terminology
    • Understanding of anatomy
    • Knowledge of basic surgical techniques
    • Knowledge of modalities and instrumentation
  • Most basic techniques for resection of structures the GI tract are essentially the same