Setup for an Exploratory Laparotomy with Possible Splenectomy (Ivy Tech Community College, Indianapolis, IN)
David Wiseman, AAS, CST
Ivy Tech Community College, Indianapolis, IN
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.
Robotic Cholecystectomy for Recurrent Gallstone Pancreatitis in a Patient with Prior Distal Pancreatectomy and Splenectomy for Acinar Cell Carcinoma
Charles C. Vining, MD, FACS, FSSO; Lawrence M. Knab, MD, FACS, FSSO; Rushin D. Brahmbhatt, MD, FACS
Penn State Health Milton S. Hershey Medical Center
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.
Setup for an Open Cholecystectomy (Eastwick College, Ramsey, NJ)
Katherine N. Soto-Rodriguez, AAS, CST; Karen L. Chambers, MHA/Ed, CST, FAST
Eastwick College, Ramsey, NJ
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.
Robotic Transversus Abdominis Release (TAR)
Katie A. Marrero, MD; Eric M. Pauli, MD, FACS, FASGE
Penn State Health Milton S. Hershey Medical Center
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.
Setup for a Breast Biopsy (Eastwick College, Ramsey, NJ)
Joseph Michael Ojeda, AAS, CST; Karen L. Chambers, MHA/Ed, CST, FAST
Eastwick College, Ramsey, NJ
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.
