1. Exploratory Laparotomy
General Surgery
Exploratory Laparotomy

2. 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.

3. 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

4. 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

5. 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

6. 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.

7. 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

8. 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