Which conditions can be treated?

Under Local Anesthesia

Skin tags/Skin Biopsy Skin cyst,Abscess Incision and Drainage of an Abscess Warts (Verruca) destruction treatment Mole removal Biopsy of growths Verruccae Benign skin naevi Hairy moles Molluscum warts Penile & vaginal warts Spider veins Hemorrhoids excision treatment In-growing toe nails Lipomas/Fatty tumors Pre-cancerous and cancerous skin lesions Laceration and Incision Repair of Skin & Soft Tissue Leg vein treatment Joint injections Trigger point injections Anal Fissure/Lateral Sphicterotomy Pilonidal Cyst and Abscess Dorsal Slit for Phimosis Breast Biopsy/Endometrial Biopsy Sample Bartholoin's Cyst/Abscess Vulvar Biopsy/ Cervical Polyps Cervical Loop Excision Biopsy Fine-Needle Aspiration Cytology and Biopsy Burn Treatment Foreign Body Removel from skin and soft tissue and many more conditions...

Definition

The excision of the foreskin (prepuce).

Discussion

Circumcisions are commonly performed on the male infant at birth or shortly thereafter. However, the uncircumcised adult may experience difficulty in retracting the prepuce from the glans of the penis because of a stricture (phimosis), which requires surgical intervention, or circumcision may be performed to treat recurrent balanitis or as a religious rite. If performed on an infant, the procedure may take place in a separate part of the newborn nursery, aseptically suited for the procedure.

Positioning

Supine, with legs slightly apart, or lithotomy. Children and infants may be placed in a frog-leg position or on a specially designed board.

Incision Site

Circumferentially around the glans penis.

Packs/ Drapes

Child: Pediatric Lap sheet Adult: Laparotomy pack Infant: Pediatric Lap sheet or folded towels

Instrumentation

Infants and children: Pediatric Lap tray Circumcision lamp Adults: Minor/ very fine tray, Probe and groove director.

Supplies/ Equipments

Basin set Blades Needle counter Catheter Gauze roll and impregnated gauze strips Solutions

Procedure 1. 2. 3. 4. If phimosis is present, a dorsal slit is made. Adhesions are lysed. A circumferential incision is made at the reflection of the foreskin, which is then excised. Hemostasis is achieved, and the wound edges are approximated using absorbable suture. For a very young infant, the skin edges are usually not approximated.

5. A strip of nonadherent gauze is placed around the incision and is covered with a gauze roll dressing. 6. A piece of umbilical tape may hold the gauze roll in place. 7. No other dressing is usually necessary. Perioperative Nursing Considerations 1. Consider the special needs of the Jewish patient for a ritual circumcision. All female team members may be asked to leave the room during the procedure. 2. Instruct the patient the proper way of cleansing the wound.

COLOSTOMY

Definition

Formation of an opening into the colon, brought out onto the abdominal wall as a stoma. The opening can be either permanent or temporary.

Specific Technique

Bowel technique

Discussion

This procedure is usually performed for lesions in the large intestine caused by cancer, diverticulitis, or obstruction of the large intestine in an area close to the rectum. Types of colostomy: 1. Temporary colostomy: A temporary colostomy is performed to divert the fecal stream from the distal colon, which may be obstructed by tumor inflammation, or requires being put-to-test because of anastomosis or a pouch procedure. A temporary colostomy may be created in the transverse colon or sigmoid colon. 2. Permanent colostomy: A permanent colostomy is performed to treat malignancies of the colon. Other indications may include irrevocable rectal strictures, incontinence of bowel, or inflammatory bowel disease. A permanent colostomy can be fashioned similar to a temporary colostomy but most often is an end colostomy.

Position

Supine, with arms extended on arm boards.

Incision Site

Dependent on the segment of colon to be used.

Packs/ Drapes

Laparotomy pack Four folded towels Transverse Lap sheet Minor pack

Instrumentation

Major Lap tray Intestinal tray Closing tray Internal surgical staples

Supplies/ Equipments

Basin set Blades Needle counter Penrose drain Internal stapling instruments Glass rod and tubing with colostomy pouch Solutions saline, water Sutures Medications Dressings

Procedure 1. The abdomen is opened in the usual manner and the segment of colon is mobilized. 2. The colon can be brought out through the main incision, or through an adjacent site from which a disk of skin and subcutaneous tissue has been excised. 3. The underlying rectus fascia muscle and peritoneal layers are incised to accommodate the colon. The appropriate segment is excised between two atraumatic (intestinal) clamps or the internal stapling instrument, which is used to prepare and create the stoma. 4. In a loop colostomy, a rod or bridge may be placed under the colon to avoid retraction. 5. The abdomen is irrigated with warm saline and closed layers in a routine fashion. 6. A colostomy poucj is applied over the stoma. Perioperative Nurisng Considerations 1. The colostomy pouch may or may not be applied in surgery.

2. A Vaseline gauze may encircle the stoma with a fluff type dressing applied. 3. If the institution has an Ostomy Nurse, the application of the colostomy pouch may be delayed until the clinical specialist can work with the patient and family. VASECTOMY Definition

Excision of a segment of the vas deferens with ligation of distal and proximal ends.

Discussion

This procedure is performed as an elective sterilization procedure or to prevent orchitis prior to a prostectomy. It can be performed under local, regional, or general anesthesia and as an out patient procedure.

Positioning

Supine, with legs slightly apart

Incision Site

Scrotum

Packs/ Drapes

Laparotomy pack or basic pack with transverse Lap sheet.

Instrumentation

Vasectomy tray or minor tray.

Supplies/ Equipment

Basin set Blades Suction Solutions Sutures Scrotal support (optional)

Procedure 1. The vas deference is palpated through the scrotum before anesthesia (local) is administered.

2. 3. 4. 5. 6.

A small incision is made in the scrotum. The vas is seized with an Allis or Bobcock clamp and is freed of surrounding tissue. A segment of the vas is excised and the ends are ligated or cauterized. The ends may be nuried within the scrotal fascia with one or two sutures. The procedure is repeated on the other side, and the incision is closed in layers.

Perioperative Nursing Considerations 1. Local anesthesia is frequently used. 2. An ice pack may be applied to the scrotum immediately after surgery. 3. A sterilization permit may be needed in addition to the operative consent.
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Salingo oopherectomy Description

The removal of one (unilateral) or both (bilateral) fallopian tubes and corresponding ovary.

Discussion

This procedure may be performed in conjunction with a hysterectomy or as a separate procedure. As a separate procedure, it is usually performed for a variety of nonmalignant diseases that include acute and chronic infection, cysts, tumors, and hemorrhage owing to tubal pregnancy. Malignancy of a tube or ovary will usually necessitate a hysterectomy with excision of the opposite adnexae.

Position

Supine, with arms extended on armboards.

Instrumentation

Major tray or abdominal hysterectomy tray. Internal stapling instruments. Self-retraining retractor.

Supplies/ Equipment

Basin set Blades Needle counter Suction Solutions saline, water

Sutures

Procedure 1. The abdomen is entered through a low midline or Pfannenstiel incision, depending on the size of the patient and the known pathologic condition. 2. The peritoneal cavity is entered and a self-retaining retractor is placed in the wound. 3. The operating table is placed in slight Trendelenberg position, and the incision is packed with moist Lap sponges. 4. The uterus is grasped with a tenaculum or uterine elevator, and if adhesions are present, the affected tube and ovary are isolated from surrounding organs. 5. The tube(s) are grasped with one or two Babcock clamps. Two Kelly or uterine clamps are then placed across the ovarian vessels. 6. The tissue is divided between the clamps with a knife, dissecting scissors, or cautery pencil. Internal staples can also be used to accomplish this task. 7. The infundibulopelvic ligament is ligated and divided, as is the broad ligament attached to the tube and ovary. The tube and ovary are excised. 8. If internal staples are not used, a suture ligature is used to ligate the ovarian vessels. 9. This procedure is repeated on the other side (if bilateral). 10. The raw surface of the ovarian ligaments left by the dissection are reperitonealized using a running suture. 11. The wound is irrigated with warm saline, and closed in a routine fashion. Perioperative Nursing Considerations 1. For bilateral surgery, a sterilization permit may be required in addition to the operative permit. 2. When the specimen is collected (if bilateral), each side should be labeled and in separate containers, depending on hospital policy.

The excision of the appendix usually performed to remove an acutely inflamed organ. Many surgeons perform an appendectomy as a prophylactic procedure when operating in the abdomen for other reasons. This procedure is then referred to as an incidental appendectomy.

Position

Supine, with arms extended on armboards

Incision Site

McBurney (muscle splitting) incision.

Packs/ Drapes

Laparotomy pack

Four folded towels

Instrumentation

Major Lap tray or minor tray Internal stapling device

Supplies/ Equipment

Basin set Blades Needle counter Penrose drain Culture tubes Solutions Sutures Internal stapling instruments Medication

Procedure 1. An incision is made in the right lower abdomen, either transversely oblique (McBurney) or vertically (for a primary appendectomy). 2. The surgeons assistant retracts the wound edges with a Richardson or similar retractor. 3. The appendix is identifies and its vascular supply ligated. 4. The surgeon grasps the appendix with a Babcock clamp, and delivers it into the wound site. 5. The tip of the appendix may then be grasped with a Kelly clamp to hold it up, and a moist Lap sponge is placed around the base of the appendix (stump) to prevent contamination of bowel contents, in case any spill out occurs during the procedure. 6. The surgeon isolates the appendix from its attachments to the bowel (mesoappendix) using a Metzenbaum scissors. 7. Taking small bits of tissue along the appendix, the mesoappendix is double-clamped, and ligated with free ties. 8. The base of the appendix is grasped with a straight Kelly clamp, and the appendix is removed. 9. The stump may be inverted into the cecum, using a purse-string suture on a fine needle, cauterize with chemicals, or simply left alone after ligation. 10. Another technique is to devascularize the appendix and invert the entire appendix into the cecum. 11. The appendix, knife, needle holder, and any clamps or scissors that have come in contact with the appendix are delivered in a basin in the circulating nurse. 12. The wound is irrigated with warm saline, and is closed in layers, except when an abscess has occurred, as with acute appendicitis. 13. A drain may be placed into the abscess cavity, exiting through the incision or a stab wound.

14. An alternative technique may be use the internal stapling device, by placing the stapling instrument around the tissue at the appendiocecum junction. 15. By using the technique, the possibility of contamination from spillage is greatly reduced. Perioperative Nursing Consideration 1. Instruments used for amputation of the appendix are to be isolated in a basin. 2. If ruptured, the case must be considered contaminated, and the surgeon may elect to use antibiotic irrigation prior to closure of the abdomen with an insertion of a drain. 3. There may be no skin closure of the wound if the appendix has rupture.