GASTRO JEJUNOSTOMY PROCEDURE 2

When is gastrojejunostomy carried out?

· Gastrojejunostomy is carried out in cases of obstruction of stomach outlet.

· This can result because of cancer or an ulcer of the stomach.

· To establish alternative connection between stomach and small intestine.

· To follow vagotomy.

Position of the patient

Supine.

Anaesthesia given during this procedure

General.

Procedure

· A midline or paramedian incision is made, next an opening is made in transverse mesocolon.

· Stomach antrum is isolated and tissue forceps is applied at lesser and greater curvature of the stomach.

· The jejunum is also held by tissue forceps loop 10 – 20 cm from duodenojejunal junction.

· Next non-crushing occlusion clamp is applied.

- Two-layer anastomosis with 2/0 chromic is now carried out. The outer is continuous (in the seromuscular layer) and the inner continuous to all layers.

- Also anastomosis is brought above the mesocolon tethered.

- Wound is closed in layers.

Instruments

General set, 1

Laparotomy set, 1

Fine artery forceps, 5

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VAGOTOMY PROCEDURES 1

VAGOTOMY

When is vagotomy done?

In cases of peptic ulcer:

· Divison of vagus nerve below diaphragm

· To reduce gastric acid secretion.

Position of the patient

Supine.

Anaesthesia

General.

Steps of surgical procedure

· The incision is given in midline/paramedian.

· Next mobilized left lobe of liver.

· Liver, colon and small intestine packed down and towards right.

· Mobilise lower oesophagus.

· Both nerves identified by palpation.

· Cut between ligatures.

· Specimen sent to histology for confirmation.

Instruments

General set, 1

Laparotomy set, 1

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VASCULAR INSTRUMENTS

VASCULAR INSTRUMENTS

Varicose stripper

Varicose stripper is used for stripping varicose veins in the long or short saphenous system.

Aneurysm needles

Aneurysm needles are of great value during surgical procedure.

They are blunt needles with handles for passing behind deep vascular pedicles after they have been clearly dissected;

the eye with the thread helps to deliver it behind the pedicle which can thus be ligated.

They were designed to ligate feeding vessels of aneurysm.

The curvature at the end is to suit the direction of the feeding vessel to be ligated.

The next three instruments are required when there is accidental injury to a vein or an artery.

De Bakey aortic is used for holding and closing the aorta or a part of it during vascular operations or injury to a last vessel.

Mini bulldog clamp serves a similar purpose for smaller arteries to hold and repair.

Satinski clamp is used for holding the slide of a vein for opening it or repairing a tear in it

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UROLOGU INSTRUMENTS 3

Urology Instruments

Some instruments used in surgery of prostate and urinary bladder

Bigelow’s evacuator bulb and cannula

The Bigelow’s evacuator bulb is shaped like a mechanical car horn.

· Pressure on the rubber bulb forces water into the bladder.

· Release of pressure sucks out water and broken stones out of the bladder.

Bigelow’s evacuator bulb and cannula are used together while doing a surgical procedure.

The cannula is shaped like a large bore metal catheter and is passed into the bladder.

Millin's boombrang needle holder

This instrument is used to stich the capsule of the prostate after

retropubic prostectomy

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UROLOGY INSTRUMENTS 2

Nephrolithotomy forceps

Identification points

· The ends have fenestrations.

· The serrations are for better grip of stone.

· There is no catch

Uses

· To remove stones from renal substance in nephrolithotomy.

· To remove stones from renal pelvis in pyelolithotomy.

Approach to the kidney

· The lumbar incision on patient’s side.

· Affected side is up.

Similar instruments

DesJardin’s gallstone forceps is also called DesJardin’s Choledocholithotomy forceps.

Differences between nephrolithotomy forceps and DesJardin’s gallstone forceps

· DesJardin’s gallstone forceps have longer blades.

    There are no serrations

 

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UROLOGY INSTRUMENTS 1

Thompson Lithotrite

Thompson lithotrite is used for crushing stones inside the urinary bladder.

Small fragments are then sucked out under negative pressure; this avoids opening the bladder.

Identification points

· This instrument can be passed into the bladder like a bougie.

· It has two blades.

· The movement of blades is controlled by a ball or wheel at the end of the handle.

· There is a scale on the handle to indicate the distance between the blades

Uses

The instrument can catch a bladder stone between the jaws and crush it.

Modern lithotrites have optical lens to allow crushing under vision

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BIOPSY NSTRUMENTS

SPECIAL INSTRUMENTS IN SURGERY

To obtain tissue for histopathologic examination is an important part of a surgeon’s functions. Scraping from cavities are obtained by Volkmann’s scoop and Sims, uterine curette; Menghini and Silverman needles obtain access through unbroken skin; and Chevalie–Jackson biopsy forceps is used for obtaining biopsy material under vision through proctoscope or a sigmoidoscope.

Biopsy instruments are used for obtaining material for histologic examination.

Those in use are as follows:

· Volkmann’s scoop

· Sims’ uterine curette

· Menghini needle

· Silverman needle

· Chevalier–Jackson biopsy forceps

Silverman biopsy needle

Identification points

· This is a fine-bore needle with a stillete that fits into the tip.

· There is a double-flange stillete that goes beyond the tip.

Uses

· TO OBTAIN A CYLINDER OF TISSUE FOR MICROSCOPIC EXAMNATION

How is biopsy done?

·The patient lies for liver biopsy, and the physician stands on the right side.

·The upper abdomen is cleaned and draped, and local anaesthesia is injected in 9^th intercostals space in the mid-axillary line (right).

·The patient holds his/her breath, and the needle with obturator is introduced.

·The spilt needle replaces obturator and cuts the tissue as a 360° turn is undertaken (360° turn).

·The tissue in the flanged stillete is put in preservation solution.

·The puncture area is sealed, and this is sent for histopathology report.

·The patient is kept under observation for 1 day.

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