Setup for a Mayo Stand During Bowel Resection
If you are partaking in an open bowel resection, it is very important to prepare properly. Some of the things you may have to prepare are the mayo stands. So what type of set up should you consider?
Procedure Involving Rectal Stapling
Usually, in this case, you will need multiple mayo stands. One is for the case’s abdominal part, and this must remain fully sterile during the entire procedure. It is also referred to as the ‘clean’ part, therefore. The second may stand is needed for the procedure’s rectal part, which is also sometimes referred to as the ‘dirty’ part. This is used to place instruments that have been used on the rectum. The rectum is a highly contaminated area with bacteria, which means the instruments cannot be reused.
In terms of instruments, the ‘clean’ mayo will need:
· Mayo clamps
· Long right angles
· Short and long needle drivers
· Short and long metz scissors
· A Richardson retractor
· Suture scissors
· A pool suction tip
· A bovie tip extender
· Tonsil clamps, one of which should be preloaded with a silk tie
· Long and short debakey forceps
· Two #10 blades
· The autosuture device the surgeon prefers to use. The GIA stapler is preferred.
The ‘dirty’ mayo will need:
· Straight may scissors
· Three or four hemostats
· Lap sponges
· Eight or so debakey forceps
· KY jelly
· An EEA stapler, although only for proximal anastomosis.
As soon as an instrument has come into contact with the inside of the bowel and/or the rectum, it is classed as contaminated. If this enters the abdomen, it can call peritonitis, which is a lethal condition. This is also why the surgeon will usually change gloves after this part of the procedure, or re-scrub. Hence, do make sure you have a few extra gloves and gowns ready as well.
Procedure that Doesn’t Involve Rectal Stapling
If the small bowel has to be addressed, there is no need for two clean and sterile mayo stands. Rather, you can use a single one and open items as you go along. This includes things like staples and long bovies. One of the reasons for this is because you will not know whether you will require thick or thin staples until the procedure is under way. Because this equipment is expensive, you don’t want to waste it by not needing it. Rather, having everything at hand, enabling the circulator to hand things over.
In this case, the mayo stand should include:
· Five curved spencer or Roberts wells.
· One mayo straight for suture cutting
· Five Dunhills
· One Nelson scissors
· One makindoe/metzenbum
· One gilles
· Two long and short debakey forceps of different sizes
· Ties with socket towel and ball clips
· BP handles with 10 blades
During the surgery, you may need to add or remove certain things. For instance, you may require a purse string applicator. Alternatively, the surgeon may prefer babcocks and sutures for bowel procedures. However, these things should be discussed in the team before setting up the procedure.