128

Access Procedures lncluding Minimol surgtcol Procedures

Gosirointestinol Surgery

r llQ

lnstrumentotion Maior Procedures traY tray Long instruments

"c

r.?*i"l".ainal procedures Self-retaining'"t'u"'oii"l"-iitrro"tl'optional

SuPPlies

tray

Basin set

Blades (2) No' 10

site of the distal colon. The distal segment is mobilized L""tt"*osed to the proximal end; an end-to-end ""a stapling device can facilitate the procedure' "rrto*.ti. ls closett; subcutaneous tissue and the skin fh" *o""a of itt" .toma site can be left open to avoid infection' -F;; ; loop or d.ouble barrel colostonr'y, an -elliptical ini* made about the stoma(s). The colonic loop is "iSo" dissected free of scar tissue and skin, and the anastomosis is performed. The proximal and distal segments order to perform anastomo-ty t""d to be resected inbowel of satisfactory {pmedr;;t well-vascularized is closed, often leaving the subcutaG.-ftt" and ;";;;"; "bdo-"tt skin packed open to prevent wound

infection.

ffff$*+*l:t*#iii:*'f
regloving, uta

'""nr#;t;

Preporotion of the Potient the patient is supine; arms may be extended on arm' r'.otit. Apply elbctrosurgical dispersive pad'

:::::il::":::lf"*::,*x:i:r;:,"i:'"":_T::
PA;:"*:lt;XI"'&';;;;;nrequires"regowning' of a Basic/lvlinor

Srh Preporotion
preqaCoser colostomy stoma with a sponge soaked in #." "lfr1ion. Begin just beyond theperimeter of the G; "it""ai"g fr-om nipples to midthighs, and down ttl" t.tf" at tf,e sides. bi""t." the area immediately

'"o'"ii'is";;;;h;;te procedures traY'

ctosuRE
Detinition
Reestablishment
OF

COLosroMY
and the repair of of colonic continurty

and the stoma -nrnd the stomacleansing the stoma' r:rA sponge after

itself last' Discard

iit?"uJt*i"al

wall'

ll[qring md.d towels

and a laparotomy or transverse sheet

Discussion

#:,"*tf- jt,ltff i-f ;m'Sli"lii:'}':*l remnant' ;i'; ;;;fi'l

rectal

r -^-+i^,,lar*

gical unit

Proce(J\rre Procedure

^.-:r-^- thq ibes rha

plocedures traY instruments traY

*r-::*,1#"J"J#&"1"'H:{iil*rilT"#::r,H stoma, whrch rs "t:il^"llii.i"" i. *"a" to enable rn tt"':l:i',:'tures. An appropnate permitting anastomosr at :'l I " "t "-o"is dissectlon'

stintal procedures traY

abdominal

(optionaD ."i"nii"ie' a*ice retr"actor (e.g., Balfour) (optional)