86 .

Surgicot Procedures lncluding Minimol Access Procedures

Abdominol Extrointesiinol Surgery o

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Supplies

Basin set Electrosurgical Pencil

Suction tubing Blades (2) No. 10, (1) No. 15 Needle magnet or counter

proaching the posterior surface where the hepatic veins enter the inferior vena cava. If bleeding is excessive, the vena cava may be controlled by the irisertion of bal_

ils divided, qauslng to ligate major vascular and biliary ehannels. Careful technique is necessary when ap_

Drainage materials

CulturJtubes (aerobic and anaerobic) Antibiotic irrigation (optional) SpeciolNotes

Determine Position of Patient' of the

lnrenchyma may be covered by greater omentum or ab_ mrbable hemostatic agents The area is drained. The
abdomen is closed in layers.

loon catheters intracavally. After hemostasis is ob_ tained and the bile ducts are ligated, the exposed

Preporotion of Potient

eff i"Jtriments thai come in contact with the abscess are isolated in a basin' --;Cf"t" ;"f"sure abdomen requires regowning'

,ugl-*irrg, and redraping and a Basic/lVlinor procedures tray. lrotect skin under adhesive tape with tincture of
benzoin.

HEPAIIC RESECTION Definition

of tumors' Refers to a small wedge biopsy, local excision or a major lobectomY.

For partial left lobe excision a subcostal approach is employed; the patient is supine with arms extended on armhoards. For major resection the approach is thora_ mabdominal; the patient is in a modified (4b.) lateral nnsition with right side uppermost. The left arm is ex_ bnded on an armboard; the right arm is supported by Mayo stand padded with a pillow (or a double arm_a board may be used). The lefl leg is extended, and the right leg is flexed with a pillory between the legs and Daddilc around the feet and ankles. The positioi is seor-ed by wide adhesive tape from the shoulders, hips, and legs to the table. Apply electrosurgical dispersive xnd.
Sdn Preporotion

Discusion
Indications for hepatic resection include trauma' cysts' ;;;;;;;, benign (e.g.. hemangioma) and malignant A preopi".g., p"i*.ty o" .".ottd.ry, i'e',.metastatic)'

"titi"u

CT scan or angiogram delineates the pathology'

1ro?9h begin at the incision (eighth interspace) ex_ hSrg from the shoulder to the iliac crest, ind jown b the table anteriorly and posteriorly. Droping
Folded towels and a transverse or laparotomy sheet

For a subcostal approach begin at the incision extend.just above the pubic symphysis, and ing from axilla to down to the table at the sides. For a posierolaieral ap_

Procedure liver to The incision is determined by the section of the of resection is determined' If a Feasibilitv il;il;. iftot..lubaominal incision is employed, the abdominal ;;;;; i" incised first' The thoracic portion of the inci:i"" i. made incising the diaphragm' Hepatic artery' *"j-ot biliarv ducis.?re controlled bv ;;;J;;;."a irr"rrtut forceps or vessel loops' The liver parenchyma

[quipment
Xlectrosurgical unit
Suctions (2)