1.

Cholecystectomy with Intraoperative Cholangiogram – Exploratory laparotomy

During a cholecystectomy, which is a surgical procedure  Stab wound through transverse colon-partial
for removing the gallbladder, you may have a procedure colectomy with anastamosis
known as intraoperative cholangiogram. In this  Control of mesenteric vascular bleeding
procedure, a catheter is placed in the cystic duct, which  Repair of left hemidiaphragm laceration
helps in draining bile into the common bile duct from the
gallbladder. 8. Appendectomy – Appendectomy is usually carried out on
an emergency basis to treat appendicitis (inflamed
An intraoperative cholangiogram is a special kind of X- appendix). A ruptured appendix can cause peritonitis,
ray imaging that shows those bile ducts. It's used during which is a potentially life-threatening complication.
surgery. With a typical X-ray, you get one picture. But a An appendectomy is the surgical removal of the
cholangiogram shows your doctor a live video of your appendix, which is located in the right lower side of the
bile ducts so they can see what's happening in real-time. abdomen. Some common symptoms of appendicitis are
nausea, vomiting, constipation and pain. The pain is
2. Thyroidectomy - Thyroidectomy is surgical removal of all initially felt in the centre of the abdomen and later moves
or part of the thyroid gland, which is located in the front to become a sharper pain in the right lower abdomen.
of the neck. The thyroid gland releases thyroid hormone, The area is tender to the touch. There is no single cause,
which controls many critical functions of the body. It may but appendicitis may be due to:
be required for patients with hyperthyroidism, goiter,  A bowel adhesion
thyroid nodules or thyroid cancer.  Swelling of the lymphatic tissue of the appendix due to a
viral infection
3. Caesarean Section - C-section, or Cesarean birth is the  A foreign body
surgical delivery of a baby through a cut (incision) made
 A faecalith (a small, hard mass of faeces), which causes
in the mother's abdomen and uterus. Cesarean delivery
blockage, inflammation and infection.
is done for medical reasons such as placenta previa,
prolapsed cord, large infant, fetal distress, or
9. Below the knee amputation - Transtibial amputation, or
malpresentation of the infant. Therefore, the operation is
below-knee amputation, is a surgical procedure
performed and is recommended because a normal
performed to fully remove a lower limb that has been
vaginal delivery is impossible or difficult and would put
damaged due to trauma, congenital defect, or
the well-being of the mother or the baby at risk.
disease. The goal of amputation is to remove unhealthy
tissue and create a remaining leg that is less painful and
4. Open Reduction Internal fixation (fracture on the knee) -
more useful. Just like many reconstructive orthopaedic
Open reduction and internal fixation (ORIF) is surgery
surgeries, the surgical goal is to improve a patient's pain
used to stabilize and heal a broken bone. Internal
and function. Amputation can improve quality of life for
fixation refers to the method of physically reconnecting
many patients.
your bones. This might involve special screws, plates,
rods, wires, or nails that your surgeon places inside your
10. Nephrectomy -Nephrectomy (nephro = kidney, ectomy =
bones to fix them in the correct place. 
removal) is the surgical removal of a kidney. The
procedure is done to treat kidney cancer as well as other
5. Radical Mastectomy - Radical mastectomy is
kidney diseases and injuries. Nephrectomy is also done
recommended only when the breast cancer has spread
to remove a healthy kidney from a donor (either living or
to the chest muscles under the breast. A radical
deceased) for transplantation. 
mastectomy removes a person’s:
 entire breast, including the areola and nipple 11. Hypospadias repair - Hypospadias repair is surgery to
 lymph nodes underneath the arm and in the armpit correct a defect in the opening of the penis that is
 tissue that covers most of the rib cage present at birth. The urethra (the tube that carries urine
 chest wall muscles underneath the breast from the bladder to outside the body) does not end at the
tip of the penis. Instead, it ends on the underside of the
6. Hysterectomy - A hysterectomy is a surgical procedure penis. In more severe cases, the urethra opens at the
whereby the uterus (womb) is removed. We may need a middle or bottom of the penis, or in or behind the
hysterectomy for many reasons. The surgery can be scrotum.
used to treat a number of chronic pain conditions as well
as certain types of cancer and infections. Depending on 12. Inguinal herniorrhaphy - An inguinal hernia occurs when
the reason for the surgery, a hysterectomy may involve tissue, such as part of the intestine, protrudes through a
removing surrounding organs and tissues, such as the weak spot in the abdominal muscles. The resulting bulge
fallopian tubes and ovaries. A partial hysterectomy can be painful, especially when you cough, bend over or
removes just the uterus, leaving the cervix intact. A total lift a heavy object. It is the surgical procedure to fix a
hysterectomy removes the uterus and the cervix. hernia. The weak spot in the muscle wall—where the
hernia bulges through—traditionally has been repaired
7. Multiple Stab wound (Exploratory Laparotomy) - A stab by sewing the edges of healthy muscle tissue together
wound is a specific form of penetrating trauma to the skin (herniorrhaphy). 
that results from a knife or a similar pointed object. An
exploratory laparotomy is an open surgical procedure for  After the Operation
visual examination of the abdominal organs, tissue and a. Instrument and Suture Nurse
blood vessels. 
 1. Help each other in the general after care of all 3. Holding the thumb over the folding edge of the sponges. She
used instruments, equipments, and the used OR picks up each sponge separately from the pack and places it in
unit as a whole. file on the table.
4. The circulating nurse immediately records the counts on a pad
2. Repacked cleansed instruments after it has been properly boiled or a sheet of paper.
and have them ready for sterilization. 5. If possible, there should be no interruptions while counting. If
Note: they are not sure of the count because of interruptions,
rumbling or any other reasons, they should repeat it.
- Check instruments against checklist in OR. Have it rechecked by 6. If a pack contains an incorrect number of sponges, the pack
the OR staff, properly label the pack with the tag bearing the should be isolated and not used (or given to the circulating
signature of the OR staff nurse to signify that the pack has been nurse). Attempts should not to be made to correct errors and or
confirmed or complete. compensate for discrepancies.

b. Circulating Nurse SUTURES

1. Reconcile closing count with scrub person. Begin count
from surgical field on patient to Mayo stand to instrument Definition
table. Sponges in sponge bucket are counted in - The noun form of suture is used for any strand of material used
increments of size and initial packaging amounts. for ligating or approximating tissue; it is also synonymous with
2. Prepare hand-off report for postprocedural area nursing stitch. The verb to suture denotes the act of sewing by bringing
staff. tissues together and holding them in approximation until healing
3. Transport patient to postprocedural area with anesthesia has taken place.
provider.
4. Give hand-off report to RN in postprocedural area. Sizes
- USP-determined sizes range from heavy 7 (largest) to very fine 1
 Patient name and age
(smallest); ranges vary with materials. Taking size 1 as a starting
 Allergies or sensitivities
point, sizes increase with each number above 1 and decrease with
 Current procedure and type of anesthesia each 0 (zero) added. The more zeroes in the number, the smaller
 Location of incisions, dressings, and drains the size of the strand. As the number of zeroes increases, the size
 Special needs (language, vision, hearing) of the strand decreases.
 Location of family or significant other
 Any procedure-specific information Classification of sutures
 Pertinent comorbidity ABSORBABLE SUTURES - they are capable of being absorbed by
living mammalian tissue but may be treated or coated to modify
resistance to absorption.
THE SPONGE AND INSTRUMENT COUNT
a. Accounting Procedure 1. Surgical Gut - is digested by body enzymes and absorbed by
- Method of counting/accounting for items on a sterile table for use tissue so that no permanent foreign body remains.
during operations. Sharps and instruments are counted four  Plain - used to ligate small vessels and to suture
times/more. subcutaneous fat.
 Chromic - used for ligation of larger vessels and for
b. Cases that Need a Count suture of tissues in which nonabsorbable materials are
 Laparotomy not usually recommended.
 Operation within the Chest cavity  Collagen Sutures - are extruded from a homogeneous
 Extraperitoneal Operations (kidney) dispersion of pure collagen fibrils from the flexor tendons
 Substernal thyroidectomies of beef.
 Deep vaginal
 Iliac Bore Graft 2. Synthetic Absorbable Polymerse - are used for ligating or
 Open on the hip joint or femur suturing except when extended approximation of tissues under
 Operation on the spine if requested stress is required. They are inert, nonantigenic, and nonpyrogenic
and produce only a mild tissue reaction during absorption.
c. Responsibility for the Count  Polydiaxanone Suture (PDS) - can be used for many
 First count – by the persons who wraps them for types of soft tissue wound repair (such as abdominal
sterilization closures) as well as for pediatric cardiac procedures.
 Second count – by the circulating nurse and scrub nurse  Poliglecaprone 25 (Monocryl) - used for general use in
together when the pack is opened for a case soft tissue repair. This suture is most commonly used to
close skin in an invisible manner.
 Third count – by the circulating nurse and scrub nurse
together when the surgeon starts the closure of the  Polyglyconate (Maxon) – has good knot security when
surgical wound extra throws are placed and is more economical than
PDS.
 Fourth count – if discrepancy is noted in any counts
 Polyglactin 910 (Vicryl) – is good for repairing hand or
 Fifth count – during washing of instruments
facial lacerations. 
CAREFUL METHODS OF COUNTING  Polyglycolic Acid (Dexon) - can be used to close clean
1. Scrub nurse holds the entire pack of sponges (or whatever tissue layers that regain sufficient strength within 7-10
types of gauze is being counted) in their hand at a time. days
2. She/he shakes the pack to separate the sponges.
NON-ABSORBABLE SUTURES - strands of natural or synthetic Rapid entry into the abdomen to control a bleeding ulcer
material that effectively resist enzymatic digestion or absorption in Gastrectomy
living tissue.
 Surgical Silk - are commonly used in peripheral closures, -Lower Abdominal Midline
ligates the blood vessels, used in micro surgeries, Hysterectomy
caesarean operations, thyroidectomy operation and Supra Pubis Prostatectomy
general closures. Cystostomy
 Surgical Cotton – used for the most part in medium sizes Salpingectomy
in general surgery. Pre-sacral lipectomy
 Surgical Stainless Steel - are the most inert among all
suture materials and provide maximum tensile strength.  -Left Side Upper Median
 Synthetic Non-absorbable Polymers Surgery of the spleen
 Surgical Nylon - it may be used in all tissues where Vasectomy
a nonabsorbable suture is acceptable, except when Gastrectomy
long-term support is critical. Repair of hiatus hernia
 Polyester Fiber - exhibit good handling properties
and a very low degree of stimulation to tissue -Right Side Upper Median
reaction. Biliary Tract surgery
 Polypropylene Suture - offers prolonged tensile
strength even in infected areas as it is not degraded -Right Lower Paramedian
over time.  Appendectomy
Small bowel resection
Suturing Techniques Surgery on right adrenal
1. Simple continuous
2. Continuous locking CONTENTS OF OPERATING ROOM PACK
3. Simple interrupted Contents of Linen Pack
4. Vertical mattress  Laparotomy sheet
5. Horizontal mattress  4 towels to drape
 2 draw sheets
TYPES OF SURGICAL INCISION  4 surgeons’ gowns
Anterior Surface Incisions  1 nurse’s gown
 3 towels for mayo tray
A. Sternotomy  Mayo tray cover
B. Kocher (Subcostal)
C. Supraumbilical
PARTS OF THE FORCEPS
D. Infraumbilical
Jaws, Box Lock, Shank, Ratchet, Finger rings
E. McBurney’s appendectomy
F. Transverse -Types of Tissues and Appropriate Needle
G. Maylard transverse muscle-cutting
 Tough tissue – cutting needle (ex. Skin, tendon, fascia,
H. Pfannenstiel
mucous membrane, cervix, tonsil, nose, tongue)
I. Thyroidectomy
J. Tracheotomy  Median tissue – rough/ cutting needle (ex. Mons,
K. Infraareolar peritoneum, muscles)
L. Inframammary  Softer tissue – round needle (ex. Viscera such as lining
M. Midline subcutaneous tissue dura)
N. Paramedian Rough – round/cutting
O. Rockey-Davis
P. Mercedes A. Graspers
Q. Chevron S – Straight Forceps
R. Epigastric (upper midline) C – Curved Forceps
S. Lower midline A – Allis Forceps
T. Pararectus B - Babcock
U. Gibson (hand-assisted laparoscopy)
V. Inguinal B. Sharps
W. Femoral  Knife
X. Clamshell  Surgical scissor
Y. Subclavicular  Metzenbaum
Z. Carotid  Needle holder
 Round
 Cutting
Uses of Incisions
 Trocar
- Kocher (Subcostal)
Right side gallbladder & biliary tract surgery
C. Tissue Forceps
Left side surgery at the spleen
 With teeth
- Upper Abdominal Midline  Without teeth
D. Retractors
E. Sutures
F. OS

Abdominal Tissue
 Skin
 Subcutaneous
 Fascia
 Muscle
 Peritoneum

Exposing Retracting Instruments

-Handheld Retractor Solid Blade
-Rake
-Double Ended
-Tongue Retractors
-Deaver Retractor
-Richardson Retractor
-Army Navy Retractor

MAJOR GYNECOLOGY INSTRUMENT SET

Retractor, kidney basin, ovum forcep, medicine glass with
betadine, specimen bottle, sharp curette, uterine sound,
tenaculum, SLM

MINOR SET