- Email: [email protected]
Theatre setup
Seminars in Pediatric Surgery 24 (2015) 229–230
Contents lists available at ScienceDirect
Seminars in Pediatric Surgery journal homepage: www.elsevier.com/locate/sempedsurg
Theatre setup Martine Siflova, BSc (Hons), Edward M. Kiely, MB ChB, FRCS (Eng.), FRCSI (I), FRCPCH, Lewis Spitz, MB ChB, PhD, FRCS (Edin., Eng.), MD, FRCS (I), FRCPCH, FAAP, FCS (SA), FACSn Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK
a r t i c l e in fo
a b s t r a c t
keywords: Operating theatre Twins Conjoined
The theatre staff would have been made aware of the special requirements for the operation at the planning meetings. Two sets of scrubs nurses will be required but only one set will be needed for the actual separation. The second set of scrub nurses will be needed only when both twins have survived the separation and the second twin is moved to another operating room for closure of the wound. & 2015 Elsevier Inc. All rights reserved.
The theatre staff, who will be directly involved with the separation, need to be included in the planning meetings. They will then be aware of special requirements for the particular set of twins under discussion, especially prior ordering of sufficient quantities of polypropylene mesh, haemostatic sealant and the availability of a functioning ultrasonic dissector. They will also be made aware of the number of medical staff required for the various stages of the separation and the needs of medical illustration to document the proceedings. Preparations will need to be in place for internal televising the operation to a site remote from the operation suite in order to limit access of the medical personnel to those essential for the procedure. Tight security will be necessary to prevent the Press from gaining access to the theatre. One large operating theatre will be used for the initial separation procedure and a second theatre should be prepared following separation for closure of the wounds in each individual twin, with the one twin allocated to the lead surgeon remaining in the large theatre and the other twin transferred to the second theatre for the attention of the assistant. A coordinator is essential to manage communication within the theatre complex and the rest of the hospital and to attend to the requirements of the multidisciplinary team but who does not participate in the surgery itself. A team brief is held just prior to the operation, as for all surgical procedures, where all members of the operation team are introduced, their role is specified and the operation schedule discussed. The anaesthetic process takes approximately 2 h including the insertion of all vascular lines and monitors, which are colour coded for each infant separately. In our hospital, conjoined twins are labelled twin one which is coded red (red team) and twin two which is blue (blue team). The surgeon in the
n
Corresponding author. E-mail address: [email protected] (L. Spitz).
http://dx.doi.org/10.1053/j.sempedsurg.2015.06.006 1055-8586/& 2015 Elsevier Inc. All rights reserved.
red team is the lead surgeon and all decisions are made through him. Adherence to this principle greatly simplifies the critical manoeuvre when the twins are moved from back to the front position and also when after separation, twin two is moved to a separate theatre. Staff and equipment For the separation procedure, the minimum number of staff will include two anaesthetic consultants and their assistants and operating department assistants (ODAs), chief scrub nurse and two assistants, two main surgeons and their assistants, camera technician and the theatre coordinator. Equipment will comprise two anaesthetic machines, two sets of monitoring stacks and pumps, a full set of operating instruments and spares, ultrasonic dissector, if required, bipolar dissector and vessel sealing devices, fibrin glue appliance apparatus and camera and video apparatus.
The separation The operating room setup is shown in Chapter 7 (anaesthetic management). The separation procedure can take anything from 4 to 12 h or more and teams will need to take rest breaks and refreshments at intervals. Food and drink must be available in the operating suite at all times. Following separation After the twins have been separated, the red twin and team remain in the base theatre, while the blue twin and team are taken to a separate theatre for closure of their incisions. Again, the transfer
230
M. Siflova et al. / Seminars in Pediatric Surgery 24 (2015) 229–230
procedure needs to be meticulously undertaken to avoid lines being entangled open wounds being exposed. The nursing team in the second theatre needs at least 30 min notice to prepare prior to transfer. Special requirements for the closure include sufficient quantities of polypropylene sheeting and plastic liner.
Postoperative The intensive care units need to be alerted to the imminent arrival of the twins well in advance so that smooth transfer can take place.
Contents lists available at ScienceDirect
Seminars in Pediatric Surgery journal homepage: www.elsevier.com/locate/sempedsurg
Theatre setup Martine Siflova, BSc (Hons), Edward M. Kiely, MB ChB, FRCS (Eng.), FRCSI (I), FRCPCH, Lewis Spitz, MB ChB, PhD, FRCS (Edin., Eng.), MD, FRCS (I), FRCPCH, FAAP, FCS (SA), FACSn Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK
a r t i c l e in fo
a b s t r a c t
keywords: Operating theatre Twins Conjoined
The theatre staff would have been made aware of the special requirements for the operation at the planning meetings. Two sets of scrubs nurses will be required but only one set will be needed for the actual separation. The second set of scrub nurses will be needed only when both twins have survived the separation and the second twin is moved to another operating room for closure of the wound. & 2015 Elsevier Inc. All rights reserved.
The theatre staff, who will be directly involved with the separation, need to be included in the planning meetings. They will then be aware of special requirements for the particular set of twins under discussion, especially prior ordering of sufficient quantities of polypropylene mesh, haemostatic sealant and the availability of a functioning ultrasonic dissector. They will also be made aware of the number of medical staff required for the various stages of the separation and the needs of medical illustration to document the proceedings. Preparations will need to be in place for internal televising the operation to a site remote from the operation suite in order to limit access of the medical personnel to those essential for the procedure. Tight security will be necessary to prevent the Press from gaining access to the theatre. One large operating theatre will be used for the initial separation procedure and a second theatre should be prepared following separation for closure of the wounds in each individual twin, with the one twin allocated to the lead surgeon remaining in the large theatre and the other twin transferred to the second theatre for the attention of the assistant. A coordinator is essential to manage communication within the theatre complex and the rest of the hospital and to attend to the requirements of the multidisciplinary team but who does not participate in the surgery itself. A team brief is held just prior to the operation, as for all surgical procedures, where all members of the operation team are introduced, their role is specified and the operation schedule discussed. The anaesthetic process takes approximately 2 h including the insertion of all vascular lines and monitors, which are colour coded for each infant separately. In our hospital, conjoined twins are labelled twin one which is coded red (red team) and twin two which is blue (blue team). The surgeon in the
n
Corresponding author. E-mail address: [email protected] (L. Spitz).
http://dx.doi.org/10.1053/j.sempedsurg.2015.06.006 1055-8586/& 2015 Elsevier Inc. All rights reserved.
red team is the lead surgeon and all decisions are made through him. Adherence to this principle greatly simplifies the critical manoeuvre when the twins are moved from back to the front position and also when after separation, twin two is moved to a separate theatre. Staff and equipment For the separation procedure, the minimum number of staff will include two anaesthetic consultants and their assistants and operating department assistants (ODAs), chief scrub nurse and two assistants, two main surgeons and their assistants, camera technician and the theatre coordinator. Equipment will comprise two anaesthetic machines, two sets of monitoring stacks and pumps, a full set of operating instruments and spares, ultrasonic dissector, if required, bipolar dissector and vessel sealing devices, fibrin glue appliance apparatus and camera and video apparatus.
The separation The operating room setup is shown in Chapter 7 (anaesthetic management). The separation procedure can take anything from 4 to 12 h or more and teams will need to take rest breaks and refreshments at intervals. Food and drink must be available in the operating suite at all times. Following separation After the twins have been separated, the red twin and team remain in the base theatre, while the blue twin and team are taken to a separate theatre for closure of their incisions. Again, the transfer
230
M. Siflova et al. / Seminars in Pediatric Surgery 24 (2015) 229–230
procedure needs to be meticulously undertaken to avoid lines being entangled open wounds being exposed. The nursing team in the second theatre needs at least 30 min notice to prepare prior to transfer. Special requirements for the closure include sufficient quantities of polypropylene sheeting and plastic liner.
Postoperative The intensive care units need to be alerted to the imminent arrival of the twins well in advance so that smooth transfer can take place.