Question

E. The surgeon has reached the level of the peritoneum, and the earlier retractor is not providing adequate retraction; what instrument might be passed?

F. The surgeon has transected the peritoneum and is ready to place a self-retaining retractor for a laparotomy; a large Bookwalter™ is not available, and this is an emergency procedure. Describe how to pass the most likely self-retaining retractor.

2. Assuming no one was relieved during the case, how many counts would you anticipate are made during the case?

Answer 1

E. A longer / deeper retractor

F. Firstly, moist lap sponges are used to pad the wounded edges. Then a Balfour retractor with blades of sufficient length to retract the wound edges is passed. If a bladder blade is used, a folded towel over the pubis is used for the padding of the retractor bar

G. An initial count, a count at the closure of the abdominal cavity and a count at the closure of the skin. Therefore, three counts

Laparotomy is also known as celiotomy. This surgical procedure is performed when the abdominal organs has to be examined /repaired. An incision is made in the abdominal wall to gain access to the abdominal cavity.

A mid line incision is made and the subcutaneous layer is cut open using a bovie. The peritoneal fat is cut and the peritoneum is checked for adhesion with the bowel. The peritoneum is cut, exposing the intestinal organs.

Retractors are used for exposing the internal organs and to move out the outer layers for optimal exposure and larger field area. Retractors are of two types: manual and seld retaining. Manual retractors are hand held by surgical assistants throughout the surgery. A self retaining retractor retracts the filed on it own using clamps.

The bookwalter retractor is a table fixed retractor. When this isn't available, the Balfour retractor is used. Balfour retractor is also a self retaining retractor but it is not table fixed. Bladder blade is used for maximum retraction in the lower abdominal area. When the desired retraction isn't available using one retractor, the blades of the retractors are changed according to the necessity.

Counts in any open surgery is important. Counts refer to the number of instruments and sponges used during the surgery. Lap pads are used in laparotomy. Usually it is counted thrice. First before the surgery, second after the closure of the abdominal cavity and finally while closing the skin. This is to make sure no surgical instruments and sponges are left inside the body which might lead to several complications such as sepsis.