Tech in Surgery Prep / Unit 25 TSC 619 review, 2 to 3 minutes
A Laparoscopic Gallbladder
The idea
A worked example, constructed for this course, follows the scrub person through a laparoscopic gallbladder removal.
In practice
Before the patient arrives, Casey, the scrub person, sets up the laparoscopic instruments, the camera and lens, the light cable, the insufflation tubing and the trocars, and keeps an open set in the room, unopened. During setup, Casey white-balances the camera with the circulating nurse and checks that the lens is clear and the light cable works. After the time out, the surgeon starts insufflation through the first port, then places the camera port and the other trocars. Casey passes graspers, a dissector and a clip applier as the surgeon works, keeping the light cable off the drapes and the electrosurgical instrument holstered between uses. The lens fogs; Casey defogs it and returns it. The surgeon clips and divides the duct and artery, then frees the gallbladder from the liver with the energy instrument. Casey has suction and irrigation ready. The gallbladder is removed through a port site and placed in a labelled container, passed to the circulating nurse. The ports are removed and counted, the gas is released, and Casey hands up suture for the small incisions. The open set was never needed.
Where people slip
Casey's preparation covered both outcomes: the laparoscopic case that happened and the open case that might have. Keeping the open set ready, unopened, is what lets a conversion begin in seconds rather than minutes. Casey also kept the light cable and the energy instrument under control throughout, because in a laparoscopic case the most serious hazards, burns and fire, can start outside the camera's view. Preparation for the unseen is a large part of minimally invasive work for the scrub person.
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