Exploratory Laparotomy General Surgery Exploratory Laparotomy

Laparotomy Laparotomy—an incision made through the abdominal wall to perform an operation on the abdominal contents Once the abdomen is opened, a particular procedure can be initiated depending on the specific conditions that are discovered. Laparotomy—an incision made through the abdominal wall to perform an operation on the abdominal contents Exploratory laparotomy—a laparotomy performed as a diagnostic procedure, when the exact nature of the patient's condition or disease is unknown Once the abdomen is opened, a particular procedure can be initiated depending on the specific conditions that are discovered.

Notes on preoperative preparation… Most facilities have a generic “Ex Lap” preference card Unless you know the specifics of the procedure, only open what you need to start the case In emergent Ex Laps the most important components to start will usually be a knife, suction, laps, and retraction A full instrument count will always be performed

Positioning, Prepping, and Draping Unless the surgery involves the lower portion of the sigmoid colon or rectum, the position will usually be supine. Always place a pillow behind the knees Arms may be on an armboard or tucked depending on surgeon’s preference Prep from nipples to midthigh Warming blanket over legs or arms SCDs Foot drape, Squared towels, Laparotomy Drape

Laparotomy-Surgical Technique Procedure Instrumentation and Intervention Skin Incision is made and carried to the fascia #3 Handle/#10 Blade Bovie Laps Hemostasis Cautery, Hemoclips, or Hemostats, Debakey Forceps, Suction Retraction of wound edges Richardson-Eastman or Self Retaining Retractor External Fascia is Divided Metzenbaum or Scalpel, Forceps Peritoneum is exposed and incised Metzenbaum Scissors, Kelly Hemostats Retraction of body wall Kochers or Richardson Ret, Suction, Laps, possible placement of Retractor System Begin Exploration

Notes for Intraoperative techniques Raytex should never be utilized unless on a sponge stick Toothed forceps should not be used past the subcutaneous layer If laps or towels are placed in the wound, it is the Scrub technician’s responsibility to know where and how many Keep the field clean; remove blood soaked laps, remove instruments from patients lap, ensure bovie tip is clean Pay attention to field depth; as the case progresses transition to appropriate length instruments, bovie tip, etc.

On to other procedures Once the abdomen is opened, hemostatic control is accomplished , and retractors are placed, any number of procedures may be performed Lysis of adhesions Bowel resection Procedures on the stomach, pancreas, liver, or spleen Exposure and retraction techniques will vary with incision type

Other procedures….. Defining and determining gastrointestinal procedures from our point of view requires; Understanding of medical terminology Understanding of anatomy Knowledge of basic surgical techniques Knowledge of modalities and instrumentation Most basic techniques for resection of structures the GI tract are essentially the same