#explore laparotomy

It has been 2 days in Bethany Hospital that Me and ate Justine Lapidario, my co on-deck have been waiting to have an OR case. Finally on the 3rd day of the duty, TAHBSO was scheduled. So before anything else, here’s the etiology I have learned before about this operation, TAHBSO or Total Abdominal Hysterectomy and Bilateral Salphingo-Oophorectomy. Hysterectomy is the removal of the uterus that may include the removal of the cervix. Salphingo is the tube that connects the ovaries to the uterus while Oophorectomy is the removal of the ovaries. So here were the series of events that happened. I was the Scrub Student Nurse, ate Justin was the Circulating Student Nurse. We first had an orientation with Sir Mark about the procedure that will be performed, he introduced me to the other nurses that will be there during the operation. It was just Ma’am Jade and Sir Umesh that I remembered. They were the ones who will be Scrubs too according to sir Mark. Sir Mark asked me if I know the Instruments such as Forceps, Mayo, Alice, Sutures and Kochers. I told him yes. He also asked me if I had breakfast, they have food on the table. Haha It was embarrassing to be asked to eat with them so it has been a reflex as I refused. Together with our Clinical Instructor Miss Louradel Ulbata and the Circulating Nurse we received the patient direct from OB Ward as endorsed by the NOD, the patient was slightly unconscious, she has an IV on her arm. The Circulating nurse took notes on the time of the endorsement and infos that were endorsed. After that the patient was transferred to the Operating Room 3. She was assisted to the Operating table, then I guess the Induction of anesthesia started. As the Scrub Circulating Nurse, I started first with of course scrubbing then I wore the sterile gown, gloves then I prepared the Instruments which were still packed. I opened the packs making sure the edges don’t touch the down part of the table which was unsterile. I arranged the instruments, first I unlocked the Instrument rack, removing the 2 towel clips that were separately used as a trap on the edges. The Instrument rack as far as I remember contains the 4 towel clips, 4 straight and 4 curve Kellies, 2 needle holders, 1 Bob Cock, 4 Alice’ and 4 Kochers. I made another Instrument rack using towel, folding and rolling it inside. I transferred the instruments there and locked them all. The other instruments that I arranged on that long curve instrument table were the 2 blade holders or knife, 1 long thumb and 1 long teeth forceps, 2 short thumb and teeth forceps, 2 Army Navy of the same size, 2 Richardson the smaller and the larger, Balfour Retractor which includes the bladder and the retaining, 1 Kidney basin, 1 round basin, 2 large Mayo and Metz Scissors, 1 cautery tip. I transferred the 2 LNPs (Long Narrow Packs), cautery tip, kellies, alice, Metz and Mayo, Blade holders on the small instrument table. I was also the one who covered the cautery wire using the fingers of gloves, it was like applying condom (words from our C.I ). Haha it was to make it sterile, then I inserted the cautery tip. After that The Circulating nurse performed Abdominal prep. My partner, Sir Umesh gave me the 1/O free tie, his was the 2/O free tie which has finer strand than mine, the 1/O. He also taught me how to insert the blade on the blade holder without using forceps or needle holder, I was using the thumb and index finger. I gave the 5 towel clips to Sir Umesh as he handled it to Dra. Roasa, the main Surgeon draping the patient while exposing the area to be incised. Next was the 2 LNPs, then the Bob Cock with cherry on it’s tip (this has nomenclature, I forgot!) then the operation began. First knife, the one which was slightly longer then the second knife was handled to the surgeon, then Kelly, then Metz and so on. The pattern I learned as the operation went through was, when the one that will be cut is tissue, Metz Scissors will be used, when it is the suture that will be cut, Mayo scissors will be used. Large Mayo and Metz are also confusing, but their difference is that the blade of Mayo is wider than that of Metz. Also when you handle it to the Surgeon, the pointing tip of the blade points TO the surgeon, you also have to handle it near the blade not on the rings which where the surgeon will grasp, the same principle of handling other instruments like the knife, you could also serve it handling the part between the blade and the blade holder. Then another pattern was Clamp-Clamp-Clamp-Metz/Knife-Suture-Mayo, you just have to look on what the surgeon is working to. When serving the suture you need to clamp the lower end of the suture. Usually with superficial opening, smaller clamps are used, Kochers were used deeper inside of the opening that was made. For the retractors, army navy were of course the first that was used, then the Richardson, then when the uterus, ovaries were already out (which the circulating nurse should take note) the Balfour Retractor was used then again Richardson then Army Navy. As a scrub you shouldn’t forget to take a look at the instruments that you serve, the cherries, the packs, sutures. Instruments that are not used should be cleaned and put back on the instrument table, when the surgeon asks for it, serve it then. Anyway specimen collected was contained on the Kidney Basin. The needles that will never be used again will be anchored on the sterile drape covering the Instrument table. You should take note of them also.  The entire procedure lasted almost 5 hours. I love everyone who was there on that Operation, there was music so it wasn’t boring. My partner, Sir Umesh which is by the way a half Indian, he was big and tall and he talks a lot which I both love and hate! HAHA hate that during the entire procedure it was him who talked much of random things that I almost failed to hear what was the instrument that was being asked by the surgeon because his voice fills the air. And love on the other way because he has been a supportive co-scrub nurse. He taught me lots of tips where I’m sure I’ll never ever encounter on the book or any other internet sites. He assisted me, encourage me to do it this way, make it that way.. It was almost 6 high fives that he asked me the entire procedure which somehow made me chill! Haha yeah, dunno why the freaking tremors of my hand were gone. I also love Ma’am Ulbata, as always, she was at my back, grasping the back of my gown, whispering what to do next. Though on the middle-end she left because she has to go to the other Operating Room where in another procedure was being done. It was overwhelming when It was already closing, collecting instruments for me to wash, I was like, “thank God it wasn’t worst that much..” hahaha I mean I made mistakes but it wasn’t that bad and If I’m given a chance to Scrub again, I’ll do it better cause I know more, cause I had learn.  I know that still I know less than half of what a Scrub Nurse should know, but now, I’m crazily thinking of being a Scrub Nurse in the future! HAHAHA I must keep reading, learning, persevering and believing!