Paul Merguerian, MD

Paul Merguerian, MD 7 Sensicare

Anesthetic plan established Preoperative antibiotics established Regional Block Type established Resident/Fellow participating established Bipolar pedal location and settings established

Determine location of next patient Need for H/P or consent of next patient Parents notified PACU orders written Postoperative antibiotics and pain medication plan established Postoperative orders written Disposition established Equipment issues Improvements

Paul Merguerian, MD 7 Sensicare

8 french feeding tube and lube Small tegaderm x 2, telfa and steri strip, coban Sutures: 5-0 prolene, 7-0 PDS, 6-0 PDS, 5-0 monocryl Bipolar cautery set to 20, pedal to right of patient Needle tip on bovie electrocautery Cut Prolene suture in half and load on needle holder Cut 7-0 PDS in half and load each half on a Castro needle holder

Postoperative pain management established Postoperative prophylactic antibiotics established Post operative appointment for stent removal made

Repair of Penile Angulation Prepare Penis Retract foreskin and clean glans Place traction stitch into glans Mark penis Insert feeding tube, drain penis 2 raytecs and betadine 5-0 Prolene, gnat, suture scissors, stage, mosquito Marking pen, 0.5mm pickup 8 fr feeding tube with lube, green towel Deglove Penis Incise skin Deglove penis Establish hemostasis 15 blade scalpel, beaver blade 0.5mm pickup, tenotomy scissors, sharpie scissors, small Wescott scissors Bipolar cautery Repair of Penile Angulation Apply tourniquet Perform erection test if needed Mark point of maximal curvature Incise Buck’s fascia Plicate penis Close Buck’s fascia Vessel loop, mosquito 27g Butterfly needle and injectable saline Marking pen 0.3mm pickup x 2 and Wescott scissors 4-0 PDS suture 6-0 PDS suture Glans Incision Mark glans Make glans incision 0.5mm pickup x 2 15 blade scalpel Sharpie scissors Urethroplasty First layer of urethroplasty Second layer of urethroplasty Create prepucial flap De-epithelialize flap Anchor flap over anastamosis 0.12mm pickup x 2 7-0 PDS on Castroviejo driver 7-0 PDS Glansplasty Close glans in 2 layers Re-approximate mucosal collar 6-0 PDS Tenotomy scissors Skin Coverage Release tourniquet Raise skin flaps Tailor and re-approximate skin Bipolar electrocautery 5-0 Monocryl Dressing Stitch traction suture to feeding tube Wash penis Apply adhesive and dressing Wets and drys Telfa and steri strip, tegaderm x 2, scissors, coban

Circulator’s Computer Video Bovie Assistant IV Pole Back table Text Text Anesth OR Table Patient’s head Text Surgeon Scrub Extra Text Foot Pedal Mayo Circulator Circulator’s Computer Door to OR

Castro Viejo Needle Driver Electrocautery with Needle Tip Text Label Straight Iris Mosquito x 2 Tenotomy 0.12mm Pickup 0.5mm Pickup Weck Spears Wescott Castro Viejo Needle Driver Adson x 2 Sharpie Gnat x 4 Bipolar Raytec Electrocautery with Needle Tip Marking Pen