Questions and Answers
What is the appropriate patient position for biliary surgery?
Which count is performed prior to the surgical procedure commencing?
What is considered the gold standard approach for performing a cholecystectomy?
What instrument is NOT typically included in the equipment for a cholecystectomy?
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Which positioning technique assists with visualization of the organ during surgery?
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What must a surgeon avoid during the cholecystectomy procedure?
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What type of injury could occur with trocar placement during laparoscopic surgery?
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Which element is NOT part of securing patient safety during surgery?
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What procedure is performed to remove the recipient's original liver during transplantation?
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What are some potential complications of CO2 insufflation during surgery?
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What is the main reason patients undergo liver transplantation?
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Which vessels are typically involved in the anastomosis process during liver transplantation?
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During the laparoscopic cholecystectomy, which port serves as the main camera port?
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What must occur before the organs can be retrieved for transplantation?
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What is the purpose of performing an intraoperative cholangiogram?
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What is the role of the hemoclips during the laparoscopic surgery?
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What is the purpose of lifelong immunosuppressants for liver transplant patients?
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Which procedure uses a catheter passed through an endoscope to diagnose issues in the biliary tract?
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What is critical to check after releasing the clamps on the portal vein and IVC?
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What happens to the portion of the donor's liver that is excised during a live donor transplantation?
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What technique is primarily used to remove stones laparoscopically during surgery?
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What role does the Trillium Gift of Life Transplant Coordinator play in organ retrieval?
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What happens to the cystic duct during an intraoperative cholangiogram?
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What sequence of actions occurs right after the skin incision in a laparoscopic procedure?
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What is the correct order for organ retrieval during a surgical procedure?
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Which type of death does NDD refer to in organ donation?
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What is one of the primary responsibilities of the perioperative nursing staff regarding postmortem care?
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Which of the following is NOT a perioperative nursing consideration during organ retrieval?
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What should be done if a patient's family wishes to see the body after an intraoperative death?
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What is critical for effective communication during an intraoperative death scenario?
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What should the perioperative team conduct to support one another after a critical incident?
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What is the purpose of a choledochoduodenostomy?
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In which population can intraoperative deaths occur?
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Which surgical procedure is typically preferred for draining pancreatic cysts located near the jejunum?
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What are the main anatomical branches supplying the pancreas from the celiac axis?
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Which of the following best describes the role of the Islets of Langerhans in the pancreas?
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What is the most common type of pancreatic cancer that affects the bile duct?
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What is the preferred surgical method used to preserve quality of life in a Whipple procedure?
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What is the primary function of the Duct of Wirsung?
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Which anastomosis method connects the common bile duct to the jejunum?
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Study Notes
Patient Positioning
- Surgical position depends on the type of procedure, with biliary surgery typically requiring the supine position.
- Refer to ORNAC Standards for proper positioning practices and checklist.
- Ensure correct placement of patient return electrode pads and forced-air warming blankets if needed.
- Safety strap must be checked and secured to prevent patient movement.
Surgical Count
- Mandatory counts include Major Initial Count, Major Closing Count (for open surgeries), and Minor Final Count (for both open and laparoscopic surgeries).
Cholecystectomy (Open or Laparoscopic)
- Procedure for gallbladder removal due to cholecystitis or cholelithiasis.
- Laparoscopic approach is preferred; open method is used only when necessary.
- Intraoperative cholangiogram may be performed if conversion to open surgery occurs.
- Requires identification and ligation of cystic artery and duct to safely extract gallbladder without bile spillage.
Instrumentation and Equipment
- Utilizes MIS Tower with a sterile laparoscope, insufflation tubing, and various trocars based on procedure type.
- Common equipment includes 5mm and 10-12mm trocars located according to surgical needs.
Procedural Considerations
- Risks include visceral or vascular injury from trocar placement, and CO2 insufflation complications (e.g., respiratory acidosis, gas embolism).
- Potential complications: bile leak, bile duct injury, jaundice, infection, and bleeding.
Operative Procedure Steps
- Skin incision made with a #11 blade; pneumoperitoneum established.
- Main camera port created via supraumbilical incision using a 10-12mm Hasson trocar.
- Additional trocars inserted for instrumentation.
- Cystic artery ligated with hemoclips; gallbladder dissected and removed through umbilical port.
Intraoperative Cholangiogram
- ERCP is a preoperative diagnostic tool for biliary tract issues that may involve stone removal.
- Intraoperative cholangiogram involves injecting contrast dye into the cystic duct to visualize blockages during surgery.
Common Biliary Anastomoses
- Choledochoduodenostomy: common bile duct anastomosed to the duodenum for bile flow restoration.
- Choledocojejunostomy: common bile duct reanastomosed to jejunum for similar purposes.
Surgery of the Pancreas: Anatomy
- The pancreas is a retroperitoneal organ with both exocrine (enzyme secretion) and endocrine (hormonal secretion) functions.
- It receives blood supply from the celiac axis, comprised of hepatic, splenic, and left gastric arteries.
Drainage or Excision of Pancreatic Cysts
- Preferred internal drainage methods include Cystojejunostomy, Cystogastrostomy, and Cystoduodenostomy based on cyst location.
Laparoscopic Whipple Resection
- Pancreaticoduodenectomy for localized pancreatic cancer, focusing on reestablishing the continuity of digestive systems post-tumor removal.
- Pylorus preserving method is preferred for better patient quality of life.
Liver Transplantation
- Involves implantation of donor liver after removing the recipient's affected liver.
- Requires lifelong immunosuppression post-transplant; donor liver can regenerate if a portion is harvested from a living donor.
Liver Anastomoses
- Key vessels (hepatic artery, portal vein, common bile duct) must be carefully anastomosed to ensure proper function and blood supply.
Organ Retrieval Surgery
- Surgical team ensures optimal conditions for organ removal, guided by consent and coordination with organ donation structure.
- Sequential removal of organs follows precise protocols to ensure effective transplantation.
Organ Donation Types
- Neurological Determination of Death (NDD) and After Circulatory Death (DCD) are two donor classifications pertinent to organ donation.
Perioperative Nursing Considerations
- Maintenance of aseptic techniques and completion of surgical safety protocols are critical during organ retrieval processes.
Operating Room Deaths
- Intraoperative deaths can occur due to various factors; the perioperative team must provide dignified postmortem care and support for the family.
- Effective communication is essential during these sensitive situations, and in case of death, support systems like spiritual care and critical incident debriefing should be utilized.
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Description
This quiz covers the essential practices for patient positioning during surgical procedures, particularly biliary surgery. It highlights the importance of using the ORNAC Standards and performance checklists to ensure patient safety and comfort. Key aspects include the application of return electrode pads, warming blankets, and securing safety straps.
