Cardio-vascular Surgery Pericardectomy

Pericardiectomy

Objective

•   To open chest

•   To excise pericardium

•   To relieve constriction of the heart.

Anesthesia

General, endotracheal.

Position

•   Supine or right semilateral

Procedure

   1.  Cleaning and draping.

   2.  Incision midsternotomy or thoracotomy.

   3.  Skin incision with knife, sponge and cutting cautery.

   4.  Separation of the pericardium with Rt. angle and cautery (cutting) and gauze piece.

   5.  Excise the pericardium.

   6.  Chest drainage tube.

   7.  Pericostal closure sponge and instruments count.

   8.  Muscle closure with 1-0 Vicryl or Dexron.

            9.         Subcutaneous 2-0 Vicryl or Dexron.

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THORACIC SURGERY Thoracoplasty

Thoracoplasty (Removal of Rib)

Objective

In cases of extensive TB of the lungs:

•   To cause a collapse of the lungs by removal of rib.

Position

Left or Right lateral position.

Anesthesia

General intubation.

Procedure

   1.  Cleaning of the patient with Savlon and painting with Tincture Iodine and draping.

   2.  Incision with No. 20 blade and No. 3 BP handle.

   3.  Cauterization with cutting cautery.

   4.  Elevation of the periosteum of the rib with periosteum elevator.

   5.  Cutting of the rib with rib cutter.

   6.  Sponge and instruments count.

   7.  Drainage: Under water seal drainage.

   8.  Muscle closure with No. 1-0 Vicryl.

   9.  Skin closure with 2-0 Vicryl.

10.  Dressing with Betadine ointment and gauze.

11.  Shifting of the patient.

Linen

Chest sheet 1 pkt, Gown 1 pkt, Chest drape 1 pkt, OPT 1 pkt.

Set

General set, water seal set, Rib resection set, Cleaning set.

Major procedure tray

•   Retractor Davidson scapula                        1

•   Duvals lung holding forceps                     2

•   Sinus rib holding forceps                          1

•   Dorham’s aneurysm needle                       2

•   Retractor Allisoi’s (Lung retractor )           1

•   Periosteum elevator notch type                 2

•   Bronchus clamp                                          2

•   Dissector W/S                                             1

•           Stinskey clamp

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Thoracic Surgery Thymectomy

Thymectomy

Objective

In cases of Myasthenia or tumors of thymus:

•   Removal of the thymus gland.

Position

Supine.

Anesthesia

General.

Procedure

1.  A sternal splitting incision.

2.  Mediastinal fat pad is incised and the thymus gland dissected from it and the underlying pericardium.

3.  Vascular attachments are ligated.

4.  To avoid the great vessels and the parathyroid glands.

5.  Hemostasis is achieved.

6.  If either pleural space has been entered a chest tube(s) and sealed drainage unit may be necessary.

Instruments

•   Thoracotomy procedure set 

•   Vascular procedures set 

•   Minor procedures set 

•   Tracheostomy tray 

•   Lebsche sternal knife 

•   Mallet 

•   Sternal saw 

•   Rake retractors 

•   Basin set 

•   Suction tubing 

•   Blades (3) No. 10, (1) No. 15 adult, (2) No. 15 children 

•   Bone wax 

•   Drain 

•   Umbilical tape 

•   Dissectors 

•   Chest tube(s) connector, and sealed drainage unit.

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Thoracic Surgery correction pectus excavatum

Correction of Pectus Excavatum

Objective

In cases of funnel chest:

•   The correction of pectus excavatum is a depression of the sternum and costal cartilages.

Position

Supine.

Anesthesia

General.

Procedure

1.  A vertical presternal incision.

2.  The origins of the pectoral muscles are reflected.

3.  Rib cartilages are separated from the sternum.

4.  Xiphoid process is transected from the sternum.

5.  An incision is made into the anterior mediastinum.

6.  The pericardium is dissected from the sternum.

7.  Wound is closed.

8.  Chest tubes, if used are attached to a sealed drainage unit.

Instruments

•   Minor orthopedic procedures tray 

•   Thoracotomy tray and Vascular procedures tray 

•   Gigli saw set 

•   Bone holding instruments set 

•   Power saw, for example Stryker 

•   Lebsche sternal knife 

•   Mallet

•   Bone tenacula (2) 

•   Awl with fenestration 

•   Pliers

•   Basin set 

•   Suction tubing 

•   Blades (3) No. 10, (1) No. 15 

•   Electrosurgical pencil 

•   Needle magnet or counter 

•   Bone wax 

•   Drains.

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