Surgery Rotation

Clinical Week 7
Kayla Dickson
 My surgery rotation was a great learning experience. I was able to observe three different

surgeries. The first was a gallbladder removal using the robot which after the removal I got to

actually hold it! The second was a colectomy, in which the patient and the last one was an ortho

surgery on the hand where the palmaris longus ligament from the right hand was used to repair

the flexor carpi radialis on the left hand.

The second surgery of the colectomy is the one I am going to reference throughout this

paper. The patient was 72 years old and recently had found a tumor on the sigmoid colon through

a colonoscopy. With colon cancer the signs and symptoms that the patient had was changes in

bowel habits, stool consistency, blood in the stool, and generalized abdominal discomfort. The

procedure for the surgery was to be done through 3 laparoscopic sites using the robot, with this

failing, they added a fourth. As the doctor stated, her colon was so perforated that it was more

harm than good to keep trying for success through the robot and decided to do it through an

abdominal incision. When making the incision site it was about 4 inches midline with the

umbilicus. When removing the malignant part of the colon, he then sewed the healthy parts back

together. Before closing her abdominal wall, he inserted his hand in through the incision site and

moved it around to feel the liver to make sure there were no masses that may have spread. After

the procedure was completely done, we all took turns holding the colon that was removed,

feeling what it should have been in comparison to the malignant tumor in which it was black,

hard, and non-movable.

For preparation of this surgery would be maintaining a special diet, making sure the

colon is completely cleaned out and was given a large container of solution to help aid with this

digestion. Also showering the night before, making sure she had comfortable clothing and taking

antibiotics as directed. Overall, the important preparation would be how she was getting to and
from the hospital and the assistance that will be provided to help her at home. When we got into

the operating room, I tried to put in a Foley Catheter but it was too big so the actual nurse

proceeded with the smaller one. This was to prevent incontinence during and after the surgery.

My observations in the room during the procedure would be seeing all the different roles

of health care providers working towards the successful outcome. There was the nurse

anesthetist, circulating nurse, scrub nurse, first assist, and the doctor. The nurse anesthetist

provided the anesthesia and maintained vitals, the circulating nurse was the nurse I followed and

he was able to go in and out of the room if something was needed, and he said his most

important role is the instrument count with the scrub nurse. The scrub nurse is the sterile nurse

that prepares the sterile field for the operation and handles the sterile equipment working aside

the doctor, along with making sure the count is correct with the circulating nurse. The first assist

worked along side the doctor throughout the whole procedure when preforming the incision,

sewing, and suturing the abdomen back up. The overall communication was good, everyone

knew what was going on. The first key was the announcement of the patient and the procedure to

be done for all in agreement to continuing. Then throughout, the scrub nurse was able to assist

with any of the instruments the doctor demanded, and if there was more that was needed to be

added to the sterile field, this was relayed to the circulating nurse to make sure there was

documentation for the overall count.

Before the surgery, the nurse took the vitals to get baselines, explained the procedure to

make sure the patient had no further questions, and assisted in the transfer to the OR bed. During

the procedure he made sure nothing came in contact with the sterile field, and had continual

count checks throughout the surgery to make sure everything was accounted for. After the

procedure he assisted with the nurse anesthetist along side the table to make sure there was no
aggression with waking up from the anesthesia. With these actions, it helped reduce the risk of

infection with maintaining sterility and safety.

The nurse was the patients advocate from the beginning to the end. He maintained quality

care and protected the patients right to help make sure the patient was safe throughout for a

smooth procedure. As the patient is not able to speak for herself. He was an advocate before the

procedure by building the trust with the patient and the family, giving them confidence that the

doctor was great and that he would take good care of her. With safety being the main concern,

the nurse calls out the proper patient and procedure. After the procedure is done, determining if

there is any other needs postoperatively for the patient or making sure to identify anything that

had changed during this was his role as well.

Overall, I really enjoyed the interaction with each health care provider inside the

operating room, and even the respect I was given outside at the nurses station. I was happy

everyone was willing to teach and explain the different procedures being done and the

techniques, tools, and reasonings for why they were doing what they were doing. I was surprised

I was able to scrub up next to the sterile field and be close to the procedure and be given the

opportunity to transfer the patient to and from the table, hold the gallbladder, attempt the Foley,

and hold the colon with the malignant tumor. It was such a great experience for my surgery

rotation.