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General Surgery

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

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  1. General Surgery Exploratory Laparotomy

  2. 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.

  3. 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

  4. 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

  5. Laparotomy-Surgical Technique

  6. 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.

  7. 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

  8. 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

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