Chapter 9: Table of Contents
A few tips for abdominal exploration and organ biopsy:
- Count your gauze squares before entering and closing the abdomen. If available, use laparotomy sponges instead of gauze sponges – they are more difficult to lose!
- Make a worth while incision – visualization is key. Remember that incisions heal from side to side not end to end!
- Keep abdominal organs moist – cover organs with moist sponges throughout the procedure. Prevent organ contact with the skin as much as possible.
- Make sure to look everywhere!
- Make a plan – if you want to perform several biopsies, begin with the cleanest organ and finish with the most contaminated organ. Create a dirty field or change your instruments (and gloves) for abdominal closure.
- Use stay sutures to retract organs – they are less traumatic than forceps.
- Prevent leaks when entering the stomach, intestine and urinary bladder. If you can’t prevent leaks, try to control the spillage with laparotomy sponges +/- suction. If spillage occurs – make sure to clean it up. If you lavage, suction or absorb the lavage fluid… leucocytes can’t eat and swim at the same time!
- If you have entered a hollow viscus, discard your dirty instruments and close with fresh instruments and gloves.
- Never leave the abdomen without biopsying something!