Question

General surgery: A surgical technology student is being supervised by the CST preceptor during a Whipple procedure. The CST comments that the student will have learned several procedures by the time they are done with this case.

1. What does the CST mean by his statement to the student?

2. What are the different procedures that constitute a Whipple procedure?

3. Discuss the different instrument trays that will be used for this case.

4. What type and size of suture is typically used for a subcuticular closure? What type of needle do you anticipate would be used?

5. Which incision is used most commonly for emergency surgery? Which incision is least likely to have an incidence of incisional herniation but a greater chance of infection or nerve damage?

Answer 1

1) Whipple procedure(also called as pancreaticoduodenectomy or PD) is a type of surgery that is used to treat pancreatic cancer (was devised by US surgeon Allen Whipple) where in head of the pancreas, the duodenum, a portion of the stomach and other nearby tissues are removed so it's basically a series of procedure which involve several resection and reconstruction..

2) Resection, cholecystectomy, pancreaticojejunostomy, choledochojejunostomy, duodenojejunostomy, duodenojejunostomy and lymphadenectomy (if required)

3) basic set abdominal adds vascular set common bile duct exploration set, bookwalter general set bookwalter retractor, set of bake dilators and a probe, cutting and dissection instruments, grasping or holding instruments, hemostatic and tissue unifying instruments and materials.

4) Vicryl (a brauded multifilament sythetic suturr, ethicon, somerville, NJ) and Monocryl (a monofilament synthetic suture, ethicon) are the commonly used suture materials for subcuticular closure. Mostly commonly used needles in whipple procedures are V-20, CV-22, CV-20 and CV-11 needles.

5) longitudinal medial or median incision is tge most likely to be used for an emergency incision and non vertical i.e horizontal incision is least likely to have incisional herniation