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 bladder 2 raytecs and betadine Monofilament suture Gnat Straight iris 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 25g Butterfly needle and injectable saline Marking pen 0.3mm pickup x 2 Wescott scissors Suture Monofilament suture Glans Incision Mark glans Make glans incision Establish hemostasis Incise plate if desired 0.5mm pickup x 2 Marking pen 15 blade scalpel Scissors Bipolar cautery +/- Small Westcott scissors Urethroplasty Create dartos or prepucial flap Anchor flap over anastamosis 0.12mm pickup x 2 Monofilament suture on Castroviejo Sharpie scissors Glansplasty Close glans in 2 layers Reapproximate mucosal collar Monofilament suture Tenotomy scissors Skin Coverage Release tourniquet Establish hemostasis Raise skin flaps Tailor and re-approximate skin Bipolar electrocautery Marking pen Tenotomy scissors Monofilament suture

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

Bovie with Colorado Tip Castro Viejo Needle Driver 0.5mm Pickup (2) 15 Blade 0.12mm Pickup (2) Lube 0.3mm Pickup (2) Marking Pen 8 Fr Feeding Tube Bacitracin Beaver Blade Gnat (2) Raytec 25g Butterfly + Saline Vessel Loop Weck Spears Bipolar Mosquito (2) Tenotomy Bovie with Colorado Tip Castro Viejo Needle Driver Sharpie Straight Iris Metzenbaum Wescott