Open total thyroidectomy is a commonly performed endocrine surgery. Using a standardized protocol for back table and Mayo stand setup can improve surgical efficiency and boost patient safety. The protocol demonstrated in this educational video covers instrument arrangement, specialized equipment preparation, and safety considerations specific to thyroid surgery. The setup includes organization of forceps, specialized bipolar energy devices, clip appliers, nerve monitoring equipment, and self-retaining retractors. Key safety measures include dual towel protection layers, separation of toothed versus smooth instruments, and sharps management. This protocol provides surgical technology students with a comprehensive framework for thyroidectomy setup and reinforces the fundamental principles of patient safety and procedural efficiency.
Excision of Suspected Chronic Infected Suture Sinus Benjamin S. C. Fung, MD, FRCSC1; Eric M. Pauli, MD, FACS, FASGE2 1North York General Hospital, University of Toronto 2Penn State Health Milton S. Hershey Medical Center
A 65-year-old female with a history of a left deep inferior epigastric perforator (DIEP) flap for breast reconstruction presented with an incisional hernia and a draining sinus tract overlying the site for her DIEP flap harvest confirmed on physical exam and cross-section imaging. She underwent a wound exploration where the entire suture sinus was excised, and it was confirmed that there was no residual foreign material left in the area. This case highlights the importance of staged abdominal wall reconstruction and addressing chronic infection before proceeding with surgery.
Excision of Infected Onlay Mesh Benjamin S. C. Fung, MD, FRCSC1; Eric M. Pauli, MD, FACS, FASGE2 1North York General Hospital, University of Toronto 2Penn State Health Milton S. Hershey Medical Center
A 73-year-old female has a history of ventral hernia repair with onlay mesh complicated by mesh infection requiring multiple debridement. She later underwent additional laparotomies for other procedures that led to her previous mesh being chronically infected and exposed to air. Multiple office debridement did not successfully remove all of the mesh. She was taken to the operating room where her onlay mesh was completely excised. This case highlights the importance of complete foreign body excision when dealing with infected prostheses of the abdominal wall.
Proper operating room setup for an exploratory laparotomy with possible splenectomy is critical for optimal surgical outcomes and patient safety. This educational video includes discussion of the proper draping sequence, warm irrigation, instrument organization, and preparation for the initial count with a circulator.
Recurrent gallstone pancreatitis is a common and potentially morbid condition for which definitive cholecystectomy is recommended to prevent recurrent biliary complications and reduce hospital readmissions. Surgical management may be technically challenging in patients with prior pancreatic resection because of altered anatomy, adhesions, and concern for malignancy recurrence. This video demonstrates a robotic-assisted cholecystectomy performed in a 78-year-old man with recurrent gallstone pancreatitis and a history of distal pancreatectomy for pancreatic acinar cell carcinoma. Preoperative imaging demonstrated cholelithiasis without evidence of recurrent malignancy. Diagnostic laparoscopy was performed to exclude occult intra-abdominal disease before proceeding with cholecystectomy. Operative findings included chronic cholecystitis and cholelithiasis. Robotic dissection facilitated meticulous clearance of fibrofatty tissue within the hepatocystic triangle and safe dissection around the cystic structures prior to cystic duct division, consistent with established principles for preventing bile duct injury. The procedure was completed without complication. This case highlights the role of robotic-assisted cholecystectomy in patients with recurrent gallstone pancreatitis and prior pancreatic surgery, where enhanced visualization and instrument dexterity may improve operative safety in complex inflammatory and reoperative settings.
The success of all surgical procedures depends, in part, on adherence to sterile technique and well-ordered arrangement of instruments and other items to support optimal efficiency. This educational video demonstrates a complete back table and Mayo stand setup for an open cholecystectomy, including preparation of the sterile field and organization of instruments and supplies in order to prepare for the initial surgical count with a circulator. Educational materials, such as this video, that provide guidance on proper setup methods, can benefit surgical technology students and new practitioners by encouraging them to create consistent perioperative practices.
A 58-year-old patient underwent robotic bilateral transversus abdominis release (TAR) for repair of a recurrent incisional hernia following prior hernia repair complicated by mesh infection and subsequent explantation. This approach was selected based on the patient’s surgical history, the size of the hernia defect, and the extent of incarcerated small bowel. A double-docking technique was employed to facilitate bilateral TAR, and a large macroporous polypropylene mesh was placed. This case highlights the operative decision-making involved in complex hernia repair and demonstrates the technical considerations for performing a robotic bilateral TAR.
In order to protect patients and facilitate a smooth surgical procedure, it is important to have all surgical instruments and supplies available and well organized. The goal of this educational video is to provide a step-by-step demonstration of how to prepare a sterile back table, Mayo stand, and ring stand for a breast biopsy, including tips on how to arrange items for maximum efficiency and how to prepare and perform the initial surgical count with a circulator.
Laparoscopic cholecystectomy is the gold standard for gallbladder removal because it provides better outcomes for patients and quicker recovery time. This video offers one perspective on how to organize one’s back table and Mayo stand for this procedure.
Surgical technologists promote maternal and neonatal patient safety during a Cesarean section (C-section) procedure by creating the sterile field, preparing a well-organized back table and Mayo stand, providing accurate surgical counts with the circulating nurse, and being prepared for possible complications. This educational video provides an example of how to arrange the sterile field, organize supplies and instrumentation, and perform the initial count with the circulating nurse.
