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Surgicol Procedures lncludihg Minimol Access Procedures Gcistrointestinol surgery

o 113

Electrosurgical cord
Pressure bag Foam padding for elbows and ankles Pneumatic antiembolitic stockings

trlOETNT OS A PERFORATED PEPIIC

IlcEN

Clip cartridge (ligating) Staple cartridge

Video.cassette (optional) Foley catheter Nasogastric tube (e.9., No. 16) Luer lock syringes (2)

Defnition

Srgical closure of a perforated gastric

Dticussion

or duodenal ulcer'

Methylene blue dye

Congo red dye

in spontaneous A complication of peptic ulcer disease

Suction tubing

**rtffi nf,x:ni*1"*H*l'i';:FHr1"; orTrt" p"tiotuiiott it""t"a bv nonsurgical

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Deans tp extensive

Suture material (optional) Fibrin sealant (e.9., Tisuol) Skin closure strips

SpeciolNotes After ihe patient is in the room, position and connect

monitors. Position the electrosurgical unit. Following draping, the scrub person passes off the camera cable, light cord, and Silastic tubing.

l#-t}rr!;;nin; teritonitis' Less of;#;;t;;i;-"ri g""""v *tv p"elet't in,sim ilar fashfor f"ot"atttut are described ion. Numeror,, peptic ulcer disease "'"g"ui ffi; ;;;llti;"' wrt""-pt"'oisting a ffiuJ";;"l*"r,i u"a i"tito""uiltiitition is limited' be performed' Ti*","*t'G* pp. iodroal mav
Procedure
(midling' nght paramedian) An upper abdominal incision and debris
is made. The site of

(between 5 and ? mm Hg), then higher flow according to the surgeon's instructions' Connecd and turn on the light source and white balance camera. The circulator turns on the VCR to record, if requested.

The circulator adjusts the insufflator, first low flow

peradherentto I":lff#'""JIf #;G;dt partiallv omentum (orthe gastrogreater foration, a portron ot ^;j^;; stapled to the stomach or .l i" ;h.;;ffi;, duodenum

peti""*ii"tiia""tified'-Fluid

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The circulator rechecks the position of monitors so they can be easily viewed. The circulator connects al.l remaining items: irrigation system, suction tubing, electrosurgical cord. All instruments (nondisposable) may be flash-sterilized..

malignancy is pe tal-<gn concomipp' ^ppt"pti",""u'"pJi"" i*lt"g"t"*v may then be performed (see Vagotomy'any) drains (if and' 106-108). After hemos"tatit i" "tt*"a *o""d it closed in the usual manner'

"itt*"a""t "t swroundn;;;; p"tro""tio"' If

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Preoorotion of the Potient' Skin 'Pt.b"iotion, DroPing, EquiPment' 'r pp ei o n d Spe c o I N otes
r

Soak scope(s) and tight cord(s) in Steris solution after thorough cleansing. Turn the room lights and overhead lights out during procedure; leave one light'on overhead for the scrub person. Lights will be turned on again when the procedure is completed.

pp' 106-108' See Vagotomy and Pyloroplasty A -u LAPAROSCOPIC CLOSURE OF

"t=ti"iitZ"ji,'su

iiirib'nauo

lcrn (wrH vAGoroMY)

Definition duodenal ulcer and Closure of perforated stomach or u"Jits branches performed lapexcision ofvagt" aroscoPicallY'

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