Cystolithotomy Surgical Steps

Preoperative Patient Preparation

• Exclusion or treatment of a urinary tract infection
• Perioperative antibiotic prophylaxis
• Supine position with slight hyperextension of the lumbar spine
• Disinfection and draping
• Insert a transurethral catheter and fill the bladder with 200–300 ml

Surgical Technique

• Lower midline incision or Pfannenstiel incision
• Cut the linea alba
• After blunt dissection of the retropubic space (cavum retzii), insert a wound retractor
• Vertical cystostomy, which is secured with sutures to prevent further tearing
• Remove bladder stones, foreign bodies or bladder tamponade, controll bleeding.
• If necessary, perform simple prostatectomy
• If needed, insert a suprapubic catheter
• Close the bladder in two layers (mucosa – muscularis)
• Drainage of retropubic space
• Closure of the linea alba, skin closure

 Open Suprapubic Cystolithotomy Surgery Video

References 

http://www.urology-textbook.com/cystolithotomy.html

6/14/2020 03:15:00 PM

Steps for Below Knee Amputation Surgery (Without Bone Bridge)

Following are the gross steps for doing a below knee amputation surgery, for detailed steps please check out these links ( Link1 and Link2 ) .

Marking the incision for flap using following parameters

• Anterior incision 10cm distal to tibial tubercle
• Anterior incision 2/3 total circumference
• Posterior incision 1/3 total circumference
• Posterior flap should be distal to the musculotendinous junction of the gastrocnemius
• Round out the distal ends of the posterior skin flap to reduce redundancy of skin upon closure

Putting the Incision and Anterior Soft Tissue Dissection

• Incision is deepened in layers
• Saphenous vein is clamped and ligated;
• Anterior incision is then carried through all tissues to bone
• Now one can identify anterior tibial artery and veins, and deep peroneal nerve anterior to interosseous membrane; anterior neurovascular bundle can always be identified by spreading between the tibialis anterior and the EHL muscles
• Incision is carried out thru lateral compartment, superficial peroneal nerve is identified, ligated proximally and cauterized

Transection of Fibula

• Fibula is transected 1-2 cm proximal to the level of the tibial transection. Periosteum of the fibula is elevated proximally before transection

Tibial transection

• Periosteal layer of the tibia is cut sharply 1 cm distal to the level of the skin and elevated proximally about 1-1.5 cm, leaving a layer for suture of the posterior musculature
• Tibia is sectioned with power saw 1 cm distal to skin edge and anterior cortex is beveled obliquely

Posterior Flap Dissection

• Posterior muscle mass is sharply and carefully freed from its attachments to the tibia and fibula distally to the level of the posterior skin incision
• Posterior tibial artery & veins and the peroneal artery and veins are individually clamped and tied
• Tibial nerve is pulled, cut proximally and allowed to retract
• Deep muscles: tibialis posterior, FDL, FHL are transected just distal to the level of the tibia and allowed to retract;
• Soleus muscle is isolated and excised, leaving the gastrocnemius as sole muscle of the myocutaneous flap
• Sural nerve is pulled, cut proximally and allowed to retract

Myodesis

• Drill holes just anterior to the bone bevel for myodesis
• Use a locking style Krackow suture through the gastrocnemius aponeurosis and secure it to the tibia
• Place a submuscular drain
• Secure the borders of the gastrocnemius to the proximal anterior fascia

Final Steps

• Wound is closed in layers
• Soft dressing is applied
• Cast is applied to immobilize the knee  to avoid a postoperative flexion contracture

2/11/2018 06:00:00 PM

Laparoscopic Appendectomy Steps



Step 1: Port placement: A 10-mm trocar is placed at the umbilicus, and the abdominal cavity is insufflated to a pressure of 15 mmHg. The camera is also inserted through this larger trocar.

A 5-mm trocar is placed at the suprapubis, and a second 5-mm trocar is placed at the LLQ.

Step 2: Inspect abdominal cavity: The area is inspected to orient the surgeon to the position of the appendix.



Step 3: Expose appendix: The bowel is gently retracted rostrally using atraumatic graspers to allow access to appendix.



Step 4: Locate and separate appendicular artery: The mesoappendix is separated from the body of the appendix, and the mesenteric fat is separated to reveal the appendicular artery. This is best done using the “spreader” action of a dissector.



Step 5: Divide appendix from cecum: Using an endoloop, two loops are placed proximal to the cecum, and a third loop is placed 1-2 cm distally to these. The appendix is then divided between the two proximal and 3rd distal loops using scissors or cautery.



Step 6: Extract appendix: The camera may be withdrawn and the existing 10 mm port used for extraction



Step 8: Irrigate: The abdominal cavity should be irrigated thoroughly with sterile saline and suctioned clean several times. In the event of a rupture, great care should be taken to ensure all pus or other infectious fluids have been removed.



Step 9: Final inspection: The abdominal and pelvic cavities are inspected one final time for any signs of infection, errors, or other potential complications.

Check out these related videos:

LAPAROSCOPIC CHOLECYSTECTOMY BY DR R. K. MISHRA

http://www.worldsurgeryforum.net/2018/02/laparoscopic-cholecystectomy-by-dr-mishra.html

GROSS ANATOMY AND SEGMENTAL ANATOMY OF LIVER

http://www.worldsurgeryforum.net/2018/02/gross-anatomy-and-segmental-anatomy-of.html

PRINCIPLES OF BOWEL ANASTOMOSIS WITH VIDEOS

http://www.worldsurgeryforum.net/2018/02/principles-of-bowel-anastomosis-video.html

MOST IMPORTANT ANATOMY IN DIAGNOSTIC LAPAROSCOPY

http://www.worldsurgeryforum.net/2018/02/Anatomy-in-Diagnostic-Laparoscopy.html

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World Surgery Forum

2/09/2018 11:18:00 PM