Myomectomy/Hysterectomy

Myomectomy
The removal of Uterine fibroids


What kind of fibroids are these?
Indications
Anemia
Secondary to uterine bleeding
Chronic severe pelvic pain
Chronic secondary dysmenorrhea
Prevents examination of adnexa
Urinary tract symptoms due to fibroids
Growth of fibroid
Infertility

Instruments
Major Set With extra allis clamps
O’connor O’Sullivan retractor or
Balfour Retractor
Positioning/Prep
The Procedure
Midline or Pfannenstiel incision

Abdominal Hysterectomy
Hysterectomy Set

Hysterectomy
The Procedure

Vaginal Hysterectomy
Position and Instrumentation
High lithotomy
Perineal prep including the vagina
Instrumentation
Vaginal hysterectomy set
The procedure
Weighted speculum and deaver retractor are placed in the vagina
The cervix is grasped with a tenaculum


A circumferential incision is made around the cervix
The anterior cuff and peritoneum is opened and the deaver is placed in the incision to retract the bladder
The posterior cuff and peritoneum is opened and the speculum is replaced with the Crisp speculum

The uterosacral ligaments are grasped with heany clamps and are tagged with suture
Just as in the open hysterectomy the dr will place a heany clamp, cut with a #10 knife and suture with pop offs.
When they reach the uterine artery and round ligaments they are clamped and double ligated.

The uterus is freed and delivered through the vagina
The vaginal cuff is closed.

When do you do your first closing count?


We create our tomorrows by what we dream today

D&C

D&C
A Review
Curettes

Bartholin’s Gland Cyst
Caused by infection or trauma
Abscess formation
I&D

Anterior/Posterior Repairs
Anterior Repair
Cystocele
Posterior Repair
Rectocele

Cystocele
Extreme Cystocele
Rectocele
Cystocele Repair
Anterior Repair

Questions
On Cystocele Repair
Rectocele Repair

Questions
On Rectocele
Vulvectomy

Questions
About Vulvectomy
Cone Biopsy

Leep
Loop Electrosurgical Excision Procedure
LEEP
Lithotomy position
LEEP insulated instruments
Bovie handpiece with loop electrodes and ball electrode
Acetic acid
Monsel’s solution



Questions
On LEEPs

Laparoscopy /Hysteroscopy

Laparoscopy
Diagnostic & Operative
Positioning
Instrumentation
Laparoscopy Set
Scope, Camera, and Light cord
D&C set
Disposable trocars
Disposable varees needle
Uterine manipulator
Two pairs of gloves for the Dr
Uterine Manipulators
Cohan Cannula
Kronner
Hulka Tenaculum
Operative Laparoscopies
Laparoscopic Set-up
Adhesions
Endometriosis
Myomas/Fibroids
Ovarian Cysts
Benign Follicular Cyst
Dermoid Cyst
Corpus Ludeum Cyst
Laparoscopic Hysterectomies
Two Types
LAVH
Supracervical
LAVH
Supracervical Hysterectomy

Pearls of Wisdom
ALWAYS check the scope for breakage when you first scrub in.
DO NOT let it touch your face shield

Hysteroscopy
Instrumentation
Hysteroscopy set
D&C set
Scope
Camera
Light cord
Hysteroscopy tubing
Diagnostic Instruments
Operative Instruments
Electrodes
Loop
Polyps
Myomas
Rollerball
Endometrial ablation
Myoma Resection
Endometrial Ablation
NovaSure
Cornu
Bicornuate Uterus

Sterilization

Sterilization
Types of Tubal Ligation
Mini Laparotomy
Laparoscopy
Ligation
Banding
Cauterization
Hulka Clips
Tubal Sterilization Techniques
Irving
Pomeroy Technique
Parkland
Madlener
Kroener
Tubal Banding
Kleppinger Bipolar
Hulka Clips
Fallopian ring applicator

Tuboplasty

Equipment
Instruments
Ectopic Pregnancy
Ectopic Pregnancies
Ectopic Surgery
This is just one of the techniques that may be used

Questions?
Reading Assignment for Next Class
ST for the ST
Laparoscopy, colposcopy and Hysteroscopy
515-521
Alexander’s
Laparoscopy and Pelviscopy
Pgs 493 – 495
Hysteroscopy and Endometrial Ablation
Pgs 487 - 490

Obstetric Surgery

Obstetric Surgery
Chapter 12
Surgical Technology
for the
Surgical Technologist
Key Terms
Braxton Hicks contractions
Cervical dilation
Cervical effacement
Crowning
Gravida
Parity
Presentation
Station
Ischial Spines
Labor
Four Stages
Stage 1
Stage 2
Stage 3
Stage 4

Anesthesia Options
No Anesthesia
Local
Epidural
General
Perineal Lacerations and Episiotomy
Tears vs. incision
Degrees
1st degree
2nd degree
3rd degree
4th degree
Movies
OB/Gyn Surgery
Repair of Second Degree Perineal Laceration
Repair of Obstetrical Anal Sphincter Lacerations
Disk 4
Cesarean Section
Preparation
Anesthesia
Position
Prep
Draping
Operative Procedure
Incisions
Dissection





Types of Uterine Incisions
Low Transverse
Vertical Midline
T Incision
Complications Leading to C-Section
Labor Complications That Can Lead to C-Section
Failure to progress
CPD
Premature Labor
Pre-eclampsia/eclampsia
Fetal Distress
Decels
Placental defects
Placenta Previa
Abruption
Prolapsed Cord
Cervical Cerclage
Questions?
Reading Assignment for Next Class
ST for the ST
Sterilization procedures and Tuboplasty
Pgs 399 – 403
Alexander’s
Tubal ligation
Pgs 508 - 510

OB/Gyn Anatomy and positioning

Obstetric and Gynecologic Anatomy and Positioning
Chapter 12
Surgical Technology for the Surgical Technologist
External Genitalia
Structures of the Female Pelvis
Uterus and Adnexa
Positioning of the Patient
Lithotomy Position

Reading assignment for the next Class

ST for the ST
Pgs 391 – 399
Alexander’s
Abdominal Surgery During Pregnancy
Pgs 513 - 516

Breast and Thyroid Surgery

Breast Surgery
Surgical Technology for the Surgical Technologist
Chapter 11
Breast Anatomy
Mammary Glands

Lymphatics
Breast Biopsy/Lumpectomy
Pathology
Mass
Cyst
Spontaneous discharge from the nipple
Suspicious mammogram
Biopsy vs. Lumpectomy
Breast Biopsy
Supine position
Anesthesia
Wide prep
Draping
Instruments on the Mayo
2- #3 knife handles
Pickups with and without teeth
Metz and mayo scissors
4 – hemostats
2 – allis clamps
2 – needle holders
Suture scissors
2 Senn retractors
2 – Army-navy retractors
Mastectomy
Segmental
Simple
Radical
Modified Radical
Segmental
Mastectomy
Simple
Mastectomy
Radical
Mastectomy
Modified
Radical
Mastectomy
Surgical Considerations
In some mastectomies the surgeon will want to include the arm in the sterile field allowing them to manipulate the arm for better visualization of the axillary area. The surgical tech will need to have a stockingette to cover the arm, and a drape sheet to cover the arm board.
Surgical Considerations
When performing a mastectomy with reconstruction you will need to have two separate setups. One for the mastectomy and one for the reconstruction.

Why do you think they do this?
Surgery of the Breast
Biopsy after needle localization
Disc 1
Sentinel lymph node dissection for breast cancer
Disc 2
Segmental mastectomy with immediate partial reconstruction
Disc 2
Surgery of the Thyroid and Parathyroid
Anatomy
Thyroidectomy
The Procedure
Instrumentation/Supplies
Thyroid Set
Vessel Clips
Bipolar cautery fcps
Drapes
¼ inch penrose
Suture according to Dr’s preference

Pearl of Wisdom
Maintain the integrity of the sterile field until the patient has been extubated, is breathing freely and has left the room. Some of these pts have intense swelling following this procedure and will need to have a tracheotomy performed. If this is the case you will not have time to pull another sterile setup.
Tracheostomy

Reading assignment for the next Class
ST for the ST
OB/Gyn Anatomy, special Instrumentation/Room setup and positioning
Pages 478-495
Alexander’s
Instrumentation through dressings
Pages 466-468
Homework
Questions for further study page 549
All of them

Surgeries of the Pancreas and Spleen

Surgeries of the Pancreas and Spleen
Surgical Technology for the Surgical Technologist
Chapter 11
The Pancreas
Four regions
Head
Neck
Body
Tail

Acini
Exocrine
Islets of Langerhans
Endocrine
Blood Supply

Pancreatectomy
Pathology
Cysts
Tumors
Pancreatitis
Inflammatory masses
Whipple
Combination of procedures
Resection
8 steps
Whipple
Reconstruction
3 steps
Pearls of Wisdom
This procedure takes a long time and requires meticulous organization of techniques and instrumentation.
If you listen to the surgeons conversation with his assistant, you will be able to pick up clues as to what he/she may want next.
Watch to see how deep the tissue is that they are working on.
Surgery of the Spleen
Splenectomy
Pathology
Trauma
External
Intraoperative
Abscess
Parasites
Splenomegaly
Spontaneous rupture

Pearls of Wisdom
Splenic trauma usually involves a large amount of bleeding. Visualization may be a problem. Have lots of laps and long clamps such as sarots to clamp the bleeding vessels.
Have long hemoclips and silk ties on long instruments such as tonsil stats or right angles

Reading Assignment for the next Class
ST for the ST
Surgery of the Breast/Thyroid
Pages 457-469
Alexander’s
Thyroid and parathyroid Surgery
Pages 626-633
Starting at Implementation on 626
Breast Surgery
Pages 647-654
Starting at Surgical Interventions on 647

Liver and Biliary Surgery

Liver and Biliary Tract
Surgeries
Liver Lacerations
Blunt trauma
Liver fracture
Penetrating trauma
Liver Segments
Surgery of the Gallbladder
Cholecystectomy
Cholelithiasis
Stones
Cholesterol
Pigmented
Cholelithiasis
Treatment for Cholelithiasis
Medication
Lithotripsy (ESWL)
Open Cholecystectomy with duct exploration
Laparoscopic Cholesystectomy
Room layout for Lap Chole
Laparoscopic Cholecystectomy
Questions?
Let’s go into the lab
and arrange the room
for a Lap Chole
Case Study
Laura is a 45-Year-old woman who is somewhat overweight, eats a typical American diet, and is generally healthy. She has been developing severe colicky pain in her right upper quadrant about 2 hours after meals. After a history and physical, she was diagnosed with cholelithiasis.
Questions
What does cholelithiasis mean?
What causes the condition?
Name three possible treatments for cholelithiasis?
If the pt must have her gallbladder removed and the procedure is done laparoscopically, what type of trocar is typically used at the umbilicus?
Reading Assignment for next Class
ST for the ST
Surgery of the Pancreas and Spleen
Pages 447-454
Alexander’s
Surgery of the Pancreas
Pages 418-423
Surgery of the Spleen
Pages 430-431
If done as an open procedure, what incision would be used?

Gastic and Intestinal Surgery

Gastric Surgery
Pathological Conditions
of the Stomach
These conditions include:
Gastric Ulcer Disease
Gastritis
Gastric Polyp (rare)
Bezoar (mass of indigestible veg fiber)
Carcinoma
Lymphoma
Gastric Procedures
Gastrostomy
The creation of a fistula tract from the gastric mucosa to the skin
Gastrostomy
(continued)
This procedure is performed to provide nutrition (feeding tube) or for decompression of the stomach.
It can be done for a short term or long term placement
The procedure can be done open or as a percutaneous puncture assisted with an EGD
Procedures Related to Gastric Secretion, Ulcers, and Neoplasm
Vagotomy
A vagotomy is the severing of the vagal nerve which interrupts the secretion of gastric acid.
Three variations
Truncal
Selective
Proximal (parietal)
Pyloroplasty
The reconstruction of the pyloric sphincter
Gastrectomy
Total
Partial
Antrectomy
Gastroduodenostomy
Billroth I and II
These are both antrectomies
Billroth I is with a reanastomosis to the duodenum
Billroth II is with a reanastomosis to the jejunum
Gastroduodenostomy
Billroth I
Procedures for Morbid Obesity
Open Gastric Stapling
Roux-en-Y Gastric Bypass
Laparoscopic Banding
Small Bowel Surgery
Pathologic Conditions of the Small Bowel
Meckel’s diverticulum
Benign neoplasm
Malignant neoplasms
Obstructions
Crohn’s disease
Common Features of Resection and Anastomosis
Supine position
General anesthesia
Margins of resection selected
Mesentery inspected
Mesenteric window created
Mesenteric resection
Colon resected
Anastomosis Options

End-to-end
End-to-Side
Side-to-Side
Colon Surgery
Diagnostic Testing
Colectomies
Right Colectomy
Right Hemicolectomy
Transverse Colectomy
Left Colectomy
Left Hemicolectomy
A/P Resection
Stomas
Iliostomy / Colostomy
Types of Stomas
End ileostomy
End loop ileostomy
End Colostomy
End Loop colostomy
Sigmoid colostomy
Anorectal Surgeries
Anorectal Surgeries
Anesthesia
Pt position
Anal Fistulas
Purulent tract
Four types
Intersphincter
Transsphincter
Suprasphincter
Extrasphincter
Anal Fistulas
Fistulotomy
Vs.
Fistulectomy
Pilonidal Fistula
More commonly called a pilonidal cyst
Pilonidal Cystectomy
Z-plasty

Hemorrhoids
O-rings
Excision
Sharp dissection
CO2 laser

Reading Assignment for next Class
ST for the ST
Surgery of the Liver and Biliary Tract
Pages 333-349
Alexander’s
Surgery of the Liver and Biliary Tract
Pages 404-418
Starting with Positioning the Patient on 404

Hernias

Abdominal Hernias
A protrusion of viscera through an opening in the wall of the abdominal cavity
Hernia Types
Reducible
Incarcerated
Strangulated
Richter’s
Sliding

Hernias
by Anatomical Location
Groin
Inguinal
Femoral
Ventral
Incisional
Diaphragmatic
Ventral Hernias
Anterior abdominal wall
Linea alba
Epigastric (1)
Hypogastric (2)
Umbilical (3)
Semilunar lines
Spigalian (4)
Incarcerated Umbilical Hernia
Direct Inguinal Hernia
Acquired
Indirect Inguinal Hernias
Congenital
Present through the inguinal ring
The sac is confined to the spermatic cord
Inguinal Hernias
Femoral Hernias
Acquired

Femoral Hernias
Instrumentation – Minor set

Instrument Counts
Some facilities require an instrument count on this case because there is a remote chance that the abdomen has to be opened to remove dead bowel

Inguinal Hernia Repair Procedure
Position – supine
Anesthetic – general, MAC, or local
Prep
Drape

Inguinal Hernia Repair Procedure
The skin incision is made and the subcutaneous tissue is dissected, with the bovie, down to the fascia.
The fascia is opened with metzenbaum scissors and forceps with teeth.
Care is taken not to cut the ilioinguinal nerve that lies beneath the fascia
Hemostats are placed on each edge of the fascia for retraction. The hernia sac is disected and a the implant is sewn into place.

The fascia is closed, the adipose, and the skin.

Inguinal Hernia
The Movie
Mesh Plug and Patch Repair
Hernia Repair Procedures
Disc 2
Laparoscopic Nissen Fundoplication
Indications

Lap Nissen
The Movie

Laparoscopic Nissen Antireflux Procedure
Gastroesophageal Surgical Procedures
Disc 4
Reading Assignment for next Class
ST for the ST
318-333
Alexanders
Surgery of the Stomach, Small bowel, Colon, Rectum
Pages 363-393

Syllabus & General anatomy

Surgical Procedures 1
The Syllabus and General Surgery Anatomy
You will need to read the chapters
You will need to take notes
I will give you information that is not in the book
Homework
You will need to write case studies
You will need to do the Vocabulary for the three chapters that we are studying
Remember to associate the words to the specialty that we are studying
Class notes
http://vc-surgtech-notes.blogspot.com
Extra Credit
Finish the chapters in the workbook and you can get extra credit
The work needs to be turned in by the time that the lectures for that chapter is complete
I will not take extra credit work after that
I will not take the last extra credit work after the tenth week
Grades
Tests (6)
20%
Participation
15%
Lab
25%
Homework
10%
Midterm
15%
Final Exam
15%
If you cannot pass the lab portion of the class you will need to retake the class before continuing with clinicals
Utmost Importance!!!
If you do not pass the final you will not pass the class
If you do not pass labs you will not pass the class
If you don’t pass the class you will not be able to continue on to clinicals
Labs
We will have a lot of practice sessions in the lab
You will need to wear scrubs to class every day
Students will be selected to scrub and circulate in the activities
Those that do not actively participate will need to observe
If you chose not to participate you will not be given a participation grades
Maintain focus and learn from the procedures
Utmost Importance!!!
This is a class that prepares you for the basic cases that you will have to perform
You will need to remember what is taught to you in this class
Do Not Just Learn to the Test!!!
We can have fun but remember this is what you came to school for!
!!!Clinical Requirements!!!
By midterm of this course students must provide documentation of acquiring a :
A physical examination stating that you have the ability to perform their job duties as a Surgical Technician.
A TB test, tetanus, MMR & Varricella vaccines
If you have had chicken pox you will need a blood titer test stating that you have antibodies
At least the first dose of the HBV immunization series
You will be responsible to provide documentation of the subsequent doses you get
If you don’t you will be pulled from clinical sites
Criminal Background Check
www.CertifiedBackground .com
Click on applicants
Click on order now
Enter package code # IR54 into the box
(Pay attention to the capitalization)
Then select payment (the cost is $45)
If you do not provide documentation of these requirements, even with a passing grade, you will not be able to attend clinicals
The program director is the only one who may see the results, he will contact you if there is a problem
General Surgery
Anatomical Review
The Abdominal Cavity
Divided into regions and quadrants
Surface Features
Of the abdominal wall
Abdominal Musculature
Peritoneum
Two kinds
Parietal
Visceral
Provides a friction free surface
Semi-permeable
Retroperitoneum
Posterior to the abdominal parietal peritoneum
What is located in the retroperitoneum?
Alimentary Canal
Also known as the digestive tract
Esophagus
Passageway from the pharynx to the stomach
Crura
Attaches the diaphragm to the spine
Stomach
Small Intestine
Ligament of Treitz
Mesentery
Peritoneal folds
Contain blood supply, nerves and lymphatics
Colon
Seven sections
Four layers
Functions
Omenta
Two separate structures
Lesser omentum
Greater omentum
Spleen
Largest lymphatic organ
Liver
Largest organ
Falciform ligament
Four lobes
Functions
Biliary Tract
Gallbladder,cystic duct, CBD, CHD
The sphincter of Oddi
Function
Morphology
Abdominal Incisions
Reading Assignment for next class
ST for the ST
Pages 292-317
Alexanders
Laparotomy/Laparoscopy
Pages 355-357
Surgery of the Esophagus
Pages 359-363
Repair of Hernias
Pages 433-453

Stone Removal

Stone Removal
Lithotripsy, Cystoscopy and Ureteroscopy
Extracorporeal Shock Wave Lithotripsy - ESWL
• Non-invasive
• Shock waves
• Kidney or upper ureteral stones
• Anesthesia
– General
• Pt position
– Semi-fowlers in a submergible chair
• Stone location
– Fluoroscopy

Endoscopic Stone Removal
• Cystoscopy
– Bladder stones
• Stone baskets
• Endoscopic lithotripsy
• Ureteroscopy
– Flexible
– Rigid

Cystostomy
Insertion of a urinary catheter through the abdominal wall
Open Cystostomy
Malecot (Mushroom) Catheter

Cystectomy/Ileal Conduit

Radical Cystectomy
• Male
– Bladder, prostate, and seminal vesicles
• Female
– Bladder, urethra, anterior vaginal wall, TAH-BSO
• Ileal Conduit

Prostatectomy

Prostatectomy
Surgical Technology
for the
Surgical Technologist
Chapter 17

Types of Prostatectomies
• Transurethral Resection of the Prostate
– TURP
• Suprapubic Prostatectomy
• Retropubic Prostatectomy
• Perineal Prostatectomy
• Transurethral Needle Ablation
– TUNA
– Not in book

TURP
• Pts are usually 60+ years old
• Typically performed in the OR or the Cysto room
• General or regional anesthetic
• Lithotomy position
• Glycine irrigation
Postoperative cathether-26fr, 30cc, 3 way
Cysto Room
Draping
Cystoscopy Instrumentation
Camera
Suprapubic Prostatectomy
• For prostates that are too large to remove endoscopically or for cancer
• Supine position
• Pfannenstiel incision

Bladder exposed
Bladder entered
Blunt dissection of the prostate
Prostate foss sutured to bladder mucosa
Bladder closed
Suprapubic Prostate Specimen
Retropubic Prostatectomy
• Performed much in the same way as the suprapubic approach
• Bladder not entered
• Provides better visualization of the prostatic fossa and better hemostatic control

Perineal prostatectomy
• Rarely used
• Provides good exposure of the prostatic fossa
• Performed in high lithotomy position with extreme trendelenburg
• Risks
– Position may cause injury to the elderly pt
– High risk of injury to the rectum
Perineal prostatectomy

TUNA-Transurethral needle ablation
• Can be performed under sedation with local
• Outpatient procedure
• Cost effective
• Uses low level radio frequency to generate frictional heat

Stress Urinary Incontinence

Stress Urinary Incontinence
Chapter 17
ST for the ST
Stress Urinary Incontinence
• Affects 1 in 4 women between the ages of 20 and 40
• Incontinence due to the stress to the pelvic musculature
• Caused by pregnancy, childbirth and the natural aging process
– Symptoms
• Leakage during coughing, sneezing, jumping

Procedures

MMK
-Marshall-Marchetti-Krantz
Stamey Procedure
TVT
-Traction free Vaginal Tape

Circumcision
Infant Circumcision
-Gomco Clamps
-Plastibell
-Mogen Clamp

Adult Circumcision
• Performed for phimosis
• Minor surgery
• Anesthesia
– Regional
– General

Vasectomy

Adrenalectomy

Adrenalectomy
The removal of one
or both adrenal glands
• Indications
• Tumor removal
• Approaches
• Laparoscopic
• Abdonminal
• retroperitoneal
• Small tumor
• Nonmalignant
• Open
• Flank incision
• Large tumor
• Malignancy

Nephrectomy
• Subtotal (Partial) Nephrectomy
• Indications
• Biopsy
• Small cancers
• Impacted calculi
• Traumatic injury
• Upper or lower poles only
• Approach
• Flank
• Renal cooling
FlankIncision
Subtotal Nephrectomy

• Total Nephrectomy
• Simple
• Flank incision
• Polycystic disease
• Nonmalignant tumors
• Harvest for transplantation
• Radical
• Abdominal approach
• Malignant tumors
Simple Nephrectomy
Abdominal Approach
Renal Transplant
• Sources
• Living relatives
• Non-related living donors
• Cadavers
• Brain dead individuals
• Advance directive
• Family authorization

Procurement
• Cadaver
• Midline incision
• Both kidneys are taken
• Preserving vessel and ureter length
• Living donor
• Simple nephrectomy
• Left kidney
Recipient Operations
• Pt gets dialysis
• Adult
• Gibson incision
• Child
• Midline abdominal incision

Genitourinary Anatomy Review

Genitourinary Anatomy
Chapter 17
Surgical Technology for the Surgical Technologist
UrinaryTract
AdrenalGland
Kidney
Nephron
Kidney
Bladder
The Male Reproductive System
Penis
• Three masses of cavernous structures
– 2-corpora cavernosa
– 1-corpus spongiosum
Urethra
Testes
VasDeferens
Prostate
Pathology
Adrenal Gland
• Cushing’s Syndrome
– Adrenal hyperactivity
• Addison’s Disease
– Adrenal insufficiency
• Pheochromocytoma
– Overproduction of adrenaline
Urinary
• Bladder tumors
– Benign
– Malignant
• Calculi
– Calcium
– Magnesium ammonium phosphate
– Uric acid
– Cystine
Kidney
• Polycystic Kidney Disease
Kidney
• Diabetic Nephropathy
– Sclerosis of the glomerulus
• End-Stage Renal Disease
– ESRD
Kidney Dialysis
Peritoneal
&
Hemodialysis
Peritoneal
Hemo-dialysis
Kidney
• Renal Cell Carcinoma
– Adenocarcinoma
• Congenital Nephroblastoma
– Wilms’ tumor

Pathology
Of the Male Reproductive System
Penis
• Phimosis
• Hypospadias/ Epispadias
Prostate
• Benign Prostatic Hyperplasia
– BPH
• Cancer of the Prostate

Testes
• Cryptorchidism
– Testicle fail to descend
• Torsion Testicle
– Twisted
• Testicular Cancer
• Varicocele

Incisions
Scrotal
-For testicular surgery
Gibson
Flank
Instrumention

Urethral Dilators
• Van BurenSounds
– Male
Cystoscopy
Resectoscope
Cystoscopy
Otis Urethrotome
Rib Spreader
Rib Constrictor

Urinary
Catheters

Myomectomy/Hysterectomy

Myomectomy
The removal of Uterine fibroids


• What kind of fibroids are these?
Indications
• Anemia
– Secondary to uterine bleeding
• Chronic severe pelvic pain
• Chronic secondary dysmenorrhea
• Prevents examination of adnexa
• Urinary tract symptoms due to fibroids
• Growth of fibroid
• Infertility

Instruments
• Major Set With extra allis clamps
• O’connor O’Sullivan retractor or
Balfour Retractor
Positioning/Prep
The Procedure
• Midline or Pfannenstiel incision

Abdominal Hysterectomy
Hysterectomy Set

Hysterectomy
The Procedure

Vaginal Hysterectomy
Position and Instrumentation
• High lithotomy
• Perineal prep including the vagina
• Instrumentation
– Vaginal hysterectomy set
The procedure
• Weighted speculum and deaver retractor are placed in the vagina
• The cervix is grasped with a tenaculum


• A circumferential incision is made around the cervix
• The anterior cuff and peritoneum is opened and the deaver is placed in the incision to retract the bladder
• The posterior cuff and peritoneum is opened and the speculum is replaced with the Crisp speculum

• The uterosacral ligaments are grasped with heany clamps and are tagged with suture
• Just as in the open hysterectomy the dr will place a heany clamp, cut with a #10 knife and suture with pop offs.
• When they reach the uterine artery and round ligaments they are clamped and double ligated.

• The uterus is freed and delivered through the vagina
• The vaginal cuff is closed.

• When do you do your first closing count?


•We create our tomorrows by what we dream today

D&C, Bartholin Cyst, A&P repairs, Cone Bx, LEEP

D&C
A Review
Curettes

Bartholin’s Gland Cyst
n Caused by infection or trauma
n Abscess formation
n I&D

Anterior/Posterior Repairs
n Anterior Repair
n Cystocele
n Posterior Repair
n Rectocele

Cystocele
Extreme Cystocele
Rectocele
Cystocele Repair
Anterior Repair

Rectocele Repair

Vulvectomy

Cone Biopsy

Leep
Loop Electrosurgical Excision Procedure
LEEP
Lithotomy position
LEEP insulated instruments
Bovie handpiece with loop electrodes and ball electrode
Acetic acid
Monsel’s solution

Laparoscopy/Hysteroscopy

Laparoscopy
Diagnostic & Operative
Positioning
Instrumentation
• Laparoscopy Set
• Scope, Camera, and Light cord
• Disposable trocars
• Disposable varees needle
• D&C set
• Uterine manipulator
• Two pairs of gloves for the Dr
Uterine Manipulators
• Cohan Cannula
• Kronner
• Hulka Tenaculum
Operative Laparoscopies

Pictures:
Laparoscopic Set-up
Adhesions
Endometriosis
Myomas/Fibroids
Ovarian Cysts
Benign Follicular Cyst
Dermoid Cyst
Corpus Ludeum Cyst

Laparoscopic Hysterectomies
• Two Types
• LAVH
• Supracervical

Pearls of Wisdom
• ALWAYS check the scope for breakage when you first scrub in.
• DO NOT let it touch your face shield

Hysteroscopy
Instrumentation
• Hysteroscopy set
• D&C set
• Scope
• Camera
• Light cord
• Hysteroscopy tubing

Diagnostic Instruments
Operative Instruments

Electrodes
• Loop
– Polyps
– Myomas
• Rollerball
- Endometrial ablation

Pictures:
Myoma Resection
Endometrial Ablation
NovaSure
Cornu
Bicornuate Uterus

Sterilization

Sterilization
Types of Tubal Ligation
• Mini Laparotomy
• Laparoscopy
– Ligation
– Banding
– Cauterization
– Hulka Clips
Tubal Sterilization Techniques
Irving
Pomeroy Technique
Parkland
Madlener
Kroener
Tubal Banding
Kleppinger Bipolar
Hulka Clips
Fallopian ring applicator

Tuboplasty

Equipment
Instruments
Ectopic Pregnancy
Ectopic Pregnancies
Ectopic Surgery
This is just one of the techniques that may be used

Questions?
Reading Assignment for Next Class
• ST for the ST
– Laparoscopy, colposcopy and Hysteroscopy
• 515-521
• Alexander’s
– Laparoscopy and Pelviscopy
• Pgs 493 – 495
– Hysteroscopy and Endometrial Ablation
• Pgs 487 - 490

Obstetric Surgery

Obstetric Surgery
Chapter 12
Surgical Technology
for the
Surgical Technologist
Key Terms
¬Braxton Hicks contractions
¬Cervical dilation
¬Cervical effacement
¬Crowning
¬Gravida
¬Parity
¬Presentation
¬Station
Ischial Spines
Labor
¬Four Stages
– Stage 1
– Stage 2
– Stage 3
– Stage 4

Anesthesia Options
¬No Anesthesia
¬Local
¬Epidural
¬General
Perineal Lacerations and Episiotomy
¬Tears vs. incision
¬Degrees
– 1st degree
– 2nd degree
– 3rd degree
– 4th degree
Movies
¬OB/Gyn Surgery
– Repair of Second Degree Perineal Laceration
– Repair of Obstetrical Anal Sphincter Lacerations
• Disk 4
Cesarean Section
Preparation
¬Anesthesia
¬Position
¬Prep
¬Draping
Operative Procedure
¬Incisions
¬Dissection





Types of Uterine Incisions
Low Transverse
Vertical Midline
T Incision
Complications Leading to C-Section
Labor Complications That Can Lead to C-Section
¬Failure to progress
– CPD
¬Premature Labor
¬Pre-eclampsia/eclampsia
¬Fetal Distress
– Decels
¬Placental defects
Placenta Previa
Abruption
Prolapsed Cord
Cervical Cerclage
Questions?
Reading Assignment for Next Class
¬ST for the ST
– Sterilization procedures and Tuboplasty
• Pgs 399 – 403
¬Alexander’s
– Tubal ligation
• Pgs 508 - 510

OB/Gyn Anatomy Notes

Obstetric and Gynecologic Anatomy and Positioning
Chapter 12
Surgical Technology for the Surgical Technologist
External Genitalia
Structures of the Female Pelvis
Uterus and Adnexa
Uterus and Adnexa
Positioning of the Patient
Lithotomy Position
•
Reading assignment for the next Class

• ST for the ST
– Pgs 391 – 399
• Alexander’s
– Abdominal Surgery During Pregnancy
• Pgs 513 - 516