Positioning of the Operating Team

Positioning of the Operating Team

The diagram indicates the usual position of the surgeon and his assistants and nurses.

The surgeon (operator) stands to the left of the patient. This is the optimum position for a right-handed surgeon operating in the lower abdomen. By shifting his feet and turning his body toward the head he is in a satisfactory position to do any necessary exploration or operation in the upper abdomen as well. By and large, this position is main­tained throughout the operative maneuvers described. Occasionally, the surgeon may shift to the opposite side of the table to have better access to the lateral structures deep in the left pelvis. When this is done, it will be indicated to the reader. Such a move is usually made when the overhanging edge of the abdominal wound interferes with exposure of the pelvic wall.

Positioning of the Operating Team

Positioning of the Operating Team

Moreover, separate bilateral procedures, such as extraperitoneal lymph node resection, will be made easier if the surgeon changes his position to the side on which the operation is to be done.

The anesthetist occupies a position at the head of the patient. The anesthesia machine, if inhalation is the chosen method, will be set up to the right of the anesthetist. The work table with his supplies and charts will be on the left. He is protected from the operating field by linen drapes over a wire hoop which attaches to the table and is adjustable either forward or backward. The wire hoop permits him to have constant direct observation of the patient’s face as well as an unobstructed working field. The patient’s right arm is extended on a board (placed beneath the mattress) to permit intravenous infusion. The upright used to support the infusion bottle is placed to the right of the anesthetist behind the board supporting the arm. The entire pathway of the intravenous fluid is under the direct vision of the anesthetist, whose duty it is to regulate the speed and quantity of the flow.

A blood pressure cuff is in place on the patient’s left arm, which is tucked beneath her body with the fingers extended. The surgeon’s movements are thus unencumbered. The tubes from the sphygmomanometer lead toward the patient’s head, allowing the anesthetist to make the neces­sary observations from behind the protective drapes.

The nurse, standing on the same side as the surgeon, is able from her position at the patient’s feet to feed the instruments to him from a Mayo stand placed over the foot of the table. The main instrument table is on her left. A second nurse, standing in front of the instrument table, anticipates the nurse’s need for supplies not available on the Mayo stand, such as suture material, sponges or infre­quently used instruments. If only one nurse is scrubbed, the larger instrument table is so placed that from her position to the left of the surgeon she may supply her own needs from it.

The first assistant stands directly opposite the surgeon just below the board carrying the patient’s extended arm. He should be cautioned not to hyperextend the patient’s shoulder by pushing too firmly against the board in his zeal to provide more effective assistance.

The second assistant, if available, usually takes his place to the right of the first assistant opposite the nurse. His job is to aid in exposure by retraction as directed.

Consistently throughout this Atlas the drawings have been made from the position which offers the most unob­structed view of the field, usually from just behind or beside the surgeon. Since the operator stands on the left side of the table, in most cases the reader may assume that the patient’s feet are toward the top of the page. A special effort has been made to keep the relationships in all plates (except for the insets and close-ups) accurate on a scale approximately two-thirds of normal size.

 Higher Surgical Training – Considerations preliminary to all abdominal surgery

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