Appendectomy Marathon

appendix attached to a straight clamp and a bobcock forcep with the first knife 

used to cut the specimen

Appendectomy is one of the most frequent operations we have in our operating room. It is a cross between a minor and a major operation.The best surgeons can perform this kind of procedure at an average time of fifteen minutes, some appendectomy can last up to an hour or two, excluding the induction of anesthesia. 


This is one of my most favorite operations (depending on the surgeon, actually) because it is very basic. Things needed beside the major basic set is a baby richardson retractor and some basic sutures. One simple basic thing to remember about appendectomy: THIS IS A PROCEDURE WHERE YOU USE THE FIRST KNIFE AFTER THE SKIN. You usually keep the first knife away from your field since it is considered as dirty. But in AP cases, we use the first knife to cut the appendix. Most of the surgeons preferred staples to close the operating site. Usually it's a small site at the right lower quadrant often referred to as McBurney's Point. 


What is Appendectomy?
Appendectomy or sometimes referred to as appendisectomy or appendicectomy is the surgical removal of the veniform appendix. This kind of surgery is normally done as an emergency procedure when the patient is suffering from acute appendicitis. 


Appendicitis
Appendicitis is the inflammation of the appendix, how do you know? Here are the list of the signs and symptoms to know if you're suffering from one:

• You can feel pain that often begins around your navel and transfers to your lower right adbomen
• The pain becomes more intense after several hours
• You can feel tenderness when you apply pressure to your lower right abdomen
• A sharp pain is felt in your right lower abdomen when the area is being pressed and the pressure is quickly released. This is referred to as rebound tenderness.
• Nausea and vomiting
• Low-grade fever

Just  remember not to drink any pain-relieving medications if you are experiencing these things because it will mask the symptoms and can delay treatment.

the arrangement of the major basic set in the mayo table. 

There are 3 Types of Incision that Surgeons often do in the hospital where I worked for:

1.    Rocky-Davis incision. This is a small incision that extend horizontally on the abdominal wall in the right lower quadrant

2.    McBurney incision. This is a small incision that runs diagonally on the abdominal wall in the right lower quadrant

3.    Midline incision- this is sometimes done if the appendix has already ruptured, they could not find the appendix, they needed a resection or for children

the back table, while the nurse is preparing for the operation. This is where we put the gown, gloves, operating sponge, drapes and the lap tray.

 

 

the mayo table (top view): army navy, thumb forceps, tissue forceps, clamps: hemostats, straight clamps, round nose, allis forceps, kochers straight, mixters,scalpel, metz, suture scissor, mayo scissors

But I hate an AP marathon. There was this one time when I was the only night duty scrub nurse and we needed to finish 4 appendectomy. I came from an 8 hour PM shift and when straight for another 8 hours. After we had the specimen out from one patient, another patient is being prepared to be wheeled in inside the operating room. I barely had time to breathe! It was a bitter sweet experience. Thank God I am with the best surgical team in the hospital :D

MAJOR BASIC SET (OPERATING ROOM INSTRUMENTS)

In our hospital, we often use the major basic set in major operations most especially during abdominal procedures. It is primarily composed of clamps, forceps and scissors. Two bowls accompany our set and retractors are added if they are need during the operation.

5 kochers straight, 5 bobcock,5 allis, 5 round nose, 5 straight clamp, 10 hemostats, 5 towel clips

Kocher (Ochsner). Used to grasp heave tissue and can be also used as a clamp. Its jaw can be straight or curve, we also utilize this to hold a peanut.

Bobcock forcep. Utilized to grasp delicate tissue such as intestine, fallopian tube, ovary, appendix, also available in long sizes

Allis Forcep. Used to grasp tissue and is available also in long sizes.

Round Nose (kelly curve). Use to clamp larger tissues or vessels.
 
Hemostat (snap/curve/straight). Use to clamp blood vessels or tag sutures. It may be straight or curve

Backhaus towel clip. Used to hold drapes, most especially towels in place

The sharps (16): tumbler, pool suction, long thumb, 2 tissue forcep, 2 thumb forcep, army navy, 2 blade holders #4, metz,mayo, 2 suture scissors, 2 needle holders

Thumb Forceps. They looked like tweezers. They are tapered and have serrations or grooves at the tip. They can be short or long, straight or bayonet (angled), and delicate or heavy

Toothed Forceps. Unlike the thumb forceps with serrations, they have row of multiple teeth at the top or single tooth on one side that fits between the two teeth on the other side. This kind of forceps provide a strong hold on tough tissues, most especially the skin.

Army Navy Retractor (also called right angle retractor/US Army retractor). Use to retract superficial or shallow incision.

Blade 4 (for Blades Size 20 and above). Use to cut the skin

Suture Scissor. Use to cut suture and supplies

Mayo Scissors (curve). Use to cut heavy tissues such as fascia, muscle, uterus, breast)
- we often use this during OB-Gyne Procedure

Metzenbaum Scisoors (Metz). Utilized to cut delicate tissues