Case Two: A Laparoscopic Gallbladder

In practice

Quinn, the scrub person, sets up the laparoscopic instruments and also keeps an open instrument set unopened in the room, because any laparoscopic case can convert to open. Before the patient arrives, Quinn checks the camera, light source and insufflation equipment with the circulating nurse. After the time out, the surgeon places the first port and the abdomen is insufflated. Quinn white-balances the camera and defogs the lens, then keeps the light cable and the energy instrument controlled on the field, because burns can start outside the camera's view. Quinn inspects each insulated instrument for damage to its insulation before passing it. The surgeon clips and divides the duct and artery, then frees the gallbladder. Quinn has the clip applier loaded and ready before the surgeon asks for it, because anticipation is the job. Bleeding from the liver bed is controlled with the energy device. The gallbladder is placed in a retrieval bag and removed through a port. Quinn receives the specimen, confirms the label with the surgeon, and passes it off to the circulating nurse. The ports are removed, the small incisions are closed, and the final counts are correct. At the sign-out, Quinn mentions that the light cable became very hot, so the equipment can be checked.