Back Table Setup for an Open Umbilical Hernia Repair
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Surgical instrument tables are considered as basic furniture for the operating room (OR). The largest table, typically rectangular or "L"-shaped, serves as a central hub for arranging and storing sterile supplies until needed during surgical procedures. The Mayo stand is an extension of the large table. It is small, height-adjustable, and intended to hang over the operating table and hold instruments and other sterile items for immediate use and within easy reach for the scrub nurse. Both the large table and the smaller Mayo stand are often referred to as back tables.1
The specific equipment and arrangement of the back table may vary depending on the type of surgery and the surgeon's preferences. It is important to ensure that the equipment is adequate but not excessive, allowing for maximum efficiency with minimal effort. Modern OR equipment is made of unpainted, corrosion-resistant metal, which is long-lasting and easy to clean. In addition, most tables have casters, which are usually made of conductive material such as metal or conductive rubber, to allow for quiet movement with minimal effort. The conductive nature of the casters and floors contributes to a safe environment in the OR.
This video provides a detailed, step-by-step guide to the back table setup for an open umbilical hernia repair surgery. It covers the preparation of the surgical field, the handling of sterile supplies, and the organization of the surgical tray. Additionally, it discusses the importance of adhering to sterile technique and the surgeon's preferences during the procedure.
Before starting the procedure, it is essential to prepare the surgical environment. This involves ensuring that all necessary supplies and equipment are available and organized. The surgical team should wear appropriate sterile attire, including gowns and gloves, to maintain a sterile environment. It is crucial to handle these sterile supplies with care to prevent contamination.
The initial part of this video describes the process of opening a standard basic pack used in surgical settings. The pack typically has two shades of blue: dark blue for sterile areas and light blue for non-sterile areas. The dark blue areas are not to be touched, while the light blue areas are considered non-sterile and can be touched. The process involves carefully opening the pack and ensuring that the sterile items inside remain untouched. It is important to maintain a distance from the table to prevent the opened items from bouncing off. Also, smaller items should be opened first to prevent larger items from bouncing off. If a package rips during the opening process, it should be discarded and replaced with a new one to avoid contamination. The overall goal of the process is to maintain sterility.
After opening the sterile supplies, it's crucial to inspect them for any damage or defects, such as rips or holes in the packaging. Any compromised items should be discarded immediately to avoid the risk of contamination. The process also involves organizing the supplies neatly to ensure efficiency during the procedure. Special attention is given to handling trays, ensuring that tags are removed without touching the sterile interior. Additionally, filters should be checked for any signs of damage before use, with verification typically conducted by a circulating nurse. Organizing the surgical tray instruments and supplies taking into account the surgeon's preferences and the specific needs of the surgeon is essential for efficiency during the procedure.
Subsequently, Kelly forceps, Pean clamps, Allis clamps, and Kocher clamps are prepared, as they may be needed during the procedure. The Bovie tip, which is used for cauterization, is also prepared. Finally, the preparation of Army-Navy and Goelet retractors, which are used to hold back tissue during the procedure, is discussed. It is suggested to have both types available, along with any other retractors that may be needed (e.g., Farabeuf retractor or Weitlaner self-retaining retractor). Stickers and a pen are kept at hand for labeling medications that may be used during the procedure. A needle driver and straight Mayo scissors are prepared, and sutures are cut into pieces, usually thirds, to facilitate their use during the procedure. Medications, including local anesthetics, are prepared and labeled immediately before being handed off. The medications are always checked with the circulating nurse before accepting them. Finally, all the necessary instruments, sutures, and lap sponges are counted. It is ensured that all necessary instruments are available and that the surgical team is properly dressed and prepared for the surgical procedure.
This video aims to serve as a valuable resource for medical professionals to have a comprehensive overview of the back table structure. A thorough understanding of surgical procedures is essential for developing OR systems, as well as improving surgical standards and patient safety. Establishing standards for instrument tables and ongoing communication between personnel are vital for a smooth and successful medical procedure. The implementation of standardized layouts may allow for faster orientation when a table is handed over between rotating personnel during lengthy procedures.2
Citations
- Dukleska K, Aka AA, Johnson AP, Chojnacki KA. Fundamentals of operating room setup and surgical instrumentation. In: Fundamentals of General Surgery. ; 2018. doi:10.1007/978-3-319-75656-1_2.
- Glaser B, Schellenberg T, Neumann J, et al. Measuring and evaluating standardization of scrub nurse instrument table setups: a multi-center study. Int J Comput Assist Radiol Surg. 2022;17(3). doi:10.1007/s11548-021-02556-1.
Cite this article
Massey D, Towfigh S. Back table setup for an open umbilical hernia repair. J Med Insight. 2024;2024(432). doi:10.24296/jomi/432.
Procedure Outline
Watch this demonstration of a back table setup for an open umbilical hernia repair by Devon Massey, CST at the Beverly Hills Hernia Center.
Transcription
CHAPTER 1
So, setting up for an open hernia repair. This is an open umbilical hernia repair. So we just have a standard basic pack right here. Just open front, open back, take your gown off the top. And now, there's different types of blue here. So the dark blue, you don't want to touch 'cause that's all considered sterile. The light blue is considered non-sterile. So that's the part you touch. You can just open up like that. Now this table is a little bigger, so you're gonna have some of the light blue on the table, but it's okay. It's all sterile still. And as you're opening, you don't want to get too close to your table, but you also don't wanna be far enough to where when you open things it just bounces off. Some things are a little more difficult to open than others, but luckily for this case, there's nothing too big. I was always taught open your smaller stuff first 'cause if you open the big stuff first and then try to open the small stuff, it'll just end up bouncing off. Just to get the closeup view of it. I can't use that. And if a package rips on you while you open it, just throw it away and get a new one. It's not worth risking the contamination or anything like that. And that's pretty much all the sterile supplies that you'll need to open. The size, the actual tray itself, which is this guy. And for opening pans, just pop your tags, take them off. Don't touch the inside because the inside is considered sterile. Check your filter, make sure no holes or anything like that. There'll be another one in the bottom. So once I take it out, the circulator will actually check it for me. And, that's about it.
CHAPTER 2
So, now that every, all the stuff is open, kind of gotta organize it, so it's not a complete mess. Luckily for this case, there's not too much stuff. So organizing it takes half a second. Kind of wanna reinforce the table with a towel just in case something gets dropped on it, something slams on it. That way you have an extra layer of protection. When you go in for your tray, just lift it at the handles. Let the circulator check the bottom of the filter. No holes. You're good. And you're good to go. Now for setups, it's always doctor preference. So if it's your first time working with a doctor, it's gonna be a little - not too correct. But as you work with the doctor more and more, you'll get more accustomed to what they like, what they want, what they need, all that good stuff. If you don't know what you need, I had a technician tell me he has a little method called it the KPAK method. So you just set up your Kelly, Peans, Allis, and Kocher clamps. I'll show you here in a little bit. Create a little roll for your stringed instruments, so that way they're not flying all over the place. I like to take out my handheld retractors just in case they might need one or the other. Sometimes they'll use one, might want another one. Happens pretty often. And just like the back table, I like to reinforce the Mayo because this is what they'll actually be setting things down on, putting things down on. So if this rips, then all your stuff becomes unsterile. Always good to have an extra layer of protection. So now I've set up my Kellys, my Peans, my Allis', and my two Kochers. So that's a little setup I like to do for these general cases. You'll always want some Adsons. Adson with Brown or Adson-Brown or Adson with teeth. Either is nice. I believe she has a fellow, so I'm gonna put up all those just to have it available. All right. Just gonna change out. This is the Bovie tip. So the Bovie usually comes with a non-guarded tip. However, usually doctors prefer the guarded tip. It's more of a finer point. Reminds them more of a blade. More accurate. Put that guy up. I like to start with Army-Navy's, but just in case have the Goelets available or any other retractors that you may have. If you have a lot of retractors, you can leave them in the tray. As long as you just remember where they are. The easier it is to get, the better. That's pretty much that. Set up the doctor's gloves and her gown. Fellow and his gown. All that. If you have meds, that's why you have the stickers and a pen. If there's meds, which there more than likely is. And then for the Rays, just lay them out. And you could throw one on the Mayo for good luck. Knife. I'll switch this one out. So there are multiple types of Bovie tips that you can have. It's always gonna come with this one. This one is your guarded one, which they use sometimes. And there's also a more of a finer needle point one that we'll use for this case. And I'm sure there are many more. I like to set out a needle driver and a straight Mayo 'cause every time you use a needle driver, they're always gonna need to cut it. Local? 1% with epi. Cool. And 0.25% marcaine... Gotcha. If you have a Telfa, just cut it up into pieces. I like thirds. Depending on the case, you might need more. You might not need it at all. But it's always nice to have a few cut up in preparation. 1% lidocaine with Epi. Expiration 3/25. Here's 20 cc. Thank you. And 0.25% marcaine. 3/26 expiration. This is 10 cc. We'll get some more. Marcaine, 0.25, 3/26. Gotcha. Okay. Thank you. And after they hand it off, that's when you label it. You said 0.25%? 0.25%. And always get some water. Water. Water or saline. Okay. Let's do it. Start with Rays. 1, 2, 3, 4, 5, 6, 7, 8, 9, 10. Hypos - two. One blade. I got three Bovie tips. No sutures yet. No laps. No. Should I get a pack? No. Okay. Yeah, that's it.