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Use of nephrostomy drape for nonendoscopic procedures
SURGEON’S
WORKSHOP
ELSEVIER
USE OF NEPHROSTOMY DRAPE FOR NONENDOSCOPIC PROCEDURES J. STUART
WOLF,
JR, DAVID
M. HOENIG,
AND
RALPH V. CLAYMAN
ABSTRACT The use of a nephrostomy drape for perineal prostatectomy and laparoscopic renal/ureteral surgery is illustrated. Draping is simplified, fixation sites for cords are present, and a large pocket for instruments and drainage is provided. The nephrostomy drape is recommended for use during operations performed on nonhorizontal surfaces, or when several instruments attached by cords are used. 0 1997, Elsevier Science inc. A// rights reserved. UROLOGY 49: 452-453, 1997.
reparation of the operating field for open abdominopelvic surgery is usually simple because the operating field is flat and easy to prepare with standard sterile drapes and because instruments are easily brought on and off the field by the scrub nurse. Endoscopic procedures, however, often are performed in positions that are unwieldy for draping with standard towels (for example, dorsal lithotomy), usually require a multitude of instruments connected to various cords that are not easily removed from the operative field when not in use, and involve irrigation fluid. Cystoscopy and nephrostomy drapes are used by many urologists for such procedures because they simplify draping of irregular surfaces, provide built-in holders for instruments and their cords, and have pockets to catch irrigation fluid. Several other procedures also require a nonhorizontal operating field or a number of instruments connected to cords. For such procedures (such as radical perineal prostatectomy and laparoscopic renal/ureteral surgery), we have used the nephrostomy drape to simplify draping and help maintain instruments on the operative field.
P
The authors presently have no~nancial interest or arrangements with the makers of the Barrier nephrostomy drape (Johnson and Johnson, Arlington, Tex). From the Section of Urology, University of Michigan, Ann Arbor, Michigan; and the Division of Urologic Surgery and Department of Radiology, Washington University, St. Louis, Missouri Correspondence:]. Stuart Wolj, Jr, M.D., The University of Michigan, Section of Urology, 1500 East Medical Center Drive, Ann Arbor, Ml 48109-0330 Submitted: August 13, 1996, accepted (with revisions): September 2 7, 1996
452
COPYRIGHT ALLRIGHTS
1997 BY ELSEVIER SCIENCE RESERVED
INC.
The Barrier nephrostomy drape (Johnson and Johnson, Arlington, Tex) is a 119 X 72-inch disposable drape with an 8 X 12-inch clear adhesive patch surrounding a 2-inch hole in the center. The purchase price at our institutions is $40. Below the clear adhesive patch is a V-shaped plastic pouch, with a finely fenestrated partition part of the way down that allows fluid to flow down to the bottom of the pouch (where suction can be applied to assist in drainage), but prevents instruments from falling through. Between the clear adhesive patch and the pouch is a built-in flexible metal strip that can be bent to help the drape conform to the operative field. On either side of the clear adhesive patch are three rows of fenestrated flaps through which can be passed cords (for example, light, suction, irrigation, electrosurgical). This drape facilitates rapid and secure draping and instrument fixation. In addition to traditional renal, ureteral, and vesical endoscopic cases, we have used the nephrostomy drape for radical perineal prostatectomy (Fig. 1) and for laparoscopic renaVuretera1 surgery (Fig. 2). For such procedures, the operating field is vertical rather than horizontal, which makes draping with standard towels tedious and time consuming. In the case of radical perineal prostatectomy, the hole in the clear adhesive patch is placed over the anus, and the drape is slit on the side opposite the plastic basin to create “wings” that are wrapped around the patient’s legs (Fig. 1). A single halfsheet is then used to drape the abdomen further. For laparoscopic renal/ureteral surgery, the clear adhesive patch is positioned over the operative field; additional slits in the patch are made as nec0090-4295/97/$17.00 PII SOO90-4295(96)00539-O
FIGURE 1. Nephrostomy drape for radical perineal prostatectomy. The perineal incision has been made. The arrow indicates where the drape was cut to form the two wings, which were then wrapped around the patient’s legs. The cords (electrosurgical, argon beam coagulator, and suction and light for illuminating aspirator) are affixed to the flaps; when not in use, these instruments are placed in the plastic pouch (visible at bottom of picture).
essary for the introduction of ports and the exposure of anatomic landmarks. The various laparoscopic cords are passed through the fenestrated flaps, thereby keeping them in place and preventing tangling (Fig. 2). In both cases, the use of the nephrostomy drape greatly speeds the draping process. Additionally, the numerous cords for operating instruments can be passed through the holes in the side flaps to fix them into place, with the instruments themselves deposited in the plastic pouch when not in use. Table I shows the cost comparison between standard draping and use of the nephrostomy drape for laparoscopic renal/ureteral procedures. The average draping time (elapsed time from the first manipulation of the drape until the operative field was ready for the start of the procedure) was determined over the course of several months at Washington University Medical Center. The greater purchase price of the nephrostomy drape is more than offset by the savings from reduced draping time, such that the use of the nephrostomy drape during laparoscopic renal/ureteral surgery resulted in an average savings of $99.75 per case.
UROLOGY
49 (31, 1997
FIGURE 2. Nephrostomy drape applied to the abdomen and flank for transperitoneal laparoscopic renal surgery, with patient in the right lateral decubitus position (head to the left). The clear adhesive portion of the drape has been centered over the operative site; slits will be made as needed in the margins of the patch to provide additional exposure. Cords are affixed to the flaps and the pouch (arrow) is oriented in a dependent position to serve as a pocket for holding instruments.
TABLE I. Comparison between standard draping and use of the nephrostomy drape for laparoscopic renallureteral procedures Standard Drapes Average draping time Operating room charge Anesthesia billing Drape charge per case Antibiotic adhesive drape charge
15 min $153.75 $63.75 $10.00 $13.75
Total
$241.25
Nephrostomy DraDe 7 min $7 1.75 $29.75 $40.00 NA $141.50
We have found that the use of a nephrostomy drape greatly simplifies draping and improves the security of instrument fixation for several nonendoscopic procedures. The nephrostomy drape is recommended for use during any operation performed on a nonhorizontal surface, or when several instruments attached by cords are required on the operative field.
453
WORKSHOP
ELSEVIER
USE OF NEPHROSTOMY DRAPE FOR NONENDOSCOPIC PROCEDURES J. STUART
WOLF,
JR, DAVID
M. HOENIG,
AND
RALPH V. CLAYMAN
ABSTRACT The use of a nephrostomy drape for perineal prostatectomy and laparoscopic renal/ureteral surgery is illustrated. Draping is simplified, fixation sites for cords are present, and a large pocket for instruments and drainage is provided. The nephrostomy drape is recommended for use during operations performed on nonhorizontal surfaces, or when several instruments attached by cords are used. 0 1997, Elsevier Science inc. A// rights reserved. UROLOGY 49: 452-453, 1997.
reparation of the operating field for open abdominopelvic surgery is usually simple because the operating field is flat and easy to prepare with standard sterile drapes and because instruments are easily brought on and off the field by the scrub nurse. Endoscopic procedures, however, often are performed in positions that are unwieldy for draping with standard towels (for example, dorsal lithotomy), usually require a multitude of instruments connected to various cords that are not easily removed from the operative field when not in use, and involve irrigation fluid. Cystoscopy and nephrostomy drapes are used by many urologists for such procedures because they simplify draping of irregular surfaces, provide built-in holders for instruments and their cords, and have pockets to catch irrigation fluid. Several other procedures also require a nonhorizontal operating field or a number of instruments connected to cords. For such procedures (such as radical perineal prostatectomy and laparoscopic renal/ureteral surgery), we have used the nephrostomy drape to simplify draping and help maintain instruments on the operative field.
P
The authors presently have no~nancial interest or arrangements with the makers of the Barrier nephrostomy drape (Johnson and Johnson, Arlington, Tex). From the Section of Urology, University of Michigan, Ann Arbor, Michigan; and the Division of Urologic Surgery and Department of Radiology, Washington University, St. Louis, Missouri Correspondence:]. Stuart Wolj, Jr, M.D., The University of Michigan, Section of Urology, 1500 East Medical Center Drive, Ann Arbor, Ml 48109-0330 Submitted: August 13, 1996, accepted (with revisions): September 2 7, 1996
452
COPYRIGHT ALLRIGHTS
1997 BY ELSEVIER SCIENCE RESERVED
INC.
The Barrier nephrostomy drape (Johnson and Johnson, Arlington, Tex) is a 119 X 72-inch disposable drape with an 8 X 12-inch clear adhesive patch surrounding a 2-inch hole in the center. The purchase price at our institutions is $40. Below the clear adhesive patch is a V-shaped plastic pouch, with a finely fenestrated partition part of the way down that allows fluid to flow down to the bottom of the pouch (where suction can be applied to assist in drainage), but prevents instruments from falling through. Between the clear adhesive patch and the pouch is a built-in flexible metal strip that can be bent to help the drape conform to the operative field. On either side of the clear adhesive patch are three rows of fenestrated flaps through which can be passed cords (for example, light, suction, irrigation, electrosurgical). This drape facilitates rapid and secure draping and instrument fixation. In addition to traditional renal, ureteral, and vesical endoscopic cases, we have used the nephrostomy drape for radical perineal prostatectomy (Fig. 1) and for laparoscopic renaVuretera1 surgery (Fig. 2). For such procedures, the operating field is vertical rather than horizontal, which makes draping with standard towels tedious and time consuming. In the case of radical perineal prostatectomy, the hole in the clear adhesive patch is placed over the anus, and the drape is slit on the side opposite the plastic basin to create “wings” that are wrapped around the patient’s legs (Fig. 1). A single halfsheet is then used to drape the abdomen further. For laparoscopic renal/ureteral surgery, the clear adhesive patch is positioned over the operative field; additional slits in the patch are made as nec0090-4295/97/$17.00 PII SOO90-4295(96)00539-O
FIGURE 1. Nephrostomy drape for radical perineal prostatectomy. The perineal incision has been made. The arrow indicates where the drape was cut to form the two wings, which were then wrapped around the patient’s legs. The cords (electrosurgical, argon beam coagulator, and suction and light for illuminating aspirator) are affixed to the flaps; when not in use, these instruments are placed in the plastic pouch (visible at bottom of picture).
essary for the introduction of ports and the exposure of anatomic landmarks. The various laparoscopic cords are passed through the fenestrated flaps, thereby keeping them in place and preventing tangling (Fig. 2). In both cases, the use of the nephrostomy drape greatly speeds the draping process. Additionally, the numerous cords for operating instruments can be passed through the holes in the side flaps to fix them into place, with the instruments themselves deposited in the plastic pouch when not in use. Table I shows the cost comparison between standard draping and use of the nephrostomy drape for laparoscopic renal/ureteral procedures. The average draping time (elapsed time from the first manipulation of the drape until the operative field was ready for the start of the procedure) was determined over the course of several months at Washington University Medical Center. The greater purchase price of the nephrostomy drape is more than offset by the savings from reduced draping time, such that the use of the nephrostomy drape during laparoscopic renal/ureteral surgery resulted in an average savings of $99.75 per case.
UROLOGY
49 (31, 1997
FIGURE 2. Nephrostomy drape applied to the abdomen and flank for transperitoneal laparoscopic renal surgery, with patient in the right lateral decubitus position (head to the left). The clear adhesive portion of the drape has been centered over the operative site; slits will be made as needed in the margins of the patch to provide additional exposure. Cords are affixed to the flaps and the pouch (arrow) is oriented in a dependent position to serve as a pocket for holding instruments.
TABLE I. Comparison between standard draping and use of the nephrostomy drape for laparoscopic renallureteral procedures Standard Drapes Average draping time Operating room charge Anesthesia billing Drape charge per case Antibiotic adhesive drape charge
15 min $153.75 $63.75 $10.00 $13.75
Total
$241.25
Nephrostomy DraDe 7 min $7 1.75 $29.75 $40.00 NA $141.50
We have found that the use of a nephrostomy drape greatly simplifies draping and improves the security of instrument fixation for several nonendoscopic procedures. The nephrostomy drape is recommended for use during any operation performed on a nonhorizontal surface, or when several instruments attached by cords are required on the operative field.
453