Richard Grady, MD Richard Grady, MD - PowerPoint Presentation

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Richard Grady, MD

Richard Grady, MD

7.5

Sensicare

Anesthetic plan established

Preoperative antibiotics established

Regional Block Type established

Resident/Fellow participating established

Bipolar pedal location and settings established

Determine location of next patient

Need for H/P or consent of next patient

Parents notified

PACU orders written

Postoperative antibiotics and pain medication plan established

Postoperative orders written

Disposition established

Equipment issues

Improvements

Richard Grady, MD

7.5

Sensicare

8

french

feeding tube and lubeSmall

tegaderm x 2, telfa and steri strip,

cobanSutures: 5-0 P

rolene, 7-0 PDS, 6-0 PDS, 5-0 Monocryl

Bipolar cautery set to 20, pedal to right of patientNeedle tip on

bovie electrocautery

Cut Prolene suture in half and load on needle holderCut 7-0 PDS in half and load each half on a Castro needle holder

Postoperative pain management established

Postoperative prophylactic antibiotics established

Post operative appointment for stent removal made

Prepare

Penis

Retract foreskin and clean glans

Place traction stitch into glans

Mark incisions

Insert feeding tube, drain penis

2

raytecs

and

betadine

5-0

Prolene

, gnat, suture scissors, stage, mosquito

Marking pen,

0.5

pickup

8

fr

feeding tube with lube, green towel

Deglove

Penis

Incise skin

Deglove

penis

Establish

hemostasis

Consider tourniquet

15 blade scalpel, beaver blade

0.5

pickup

, tenotomy scissors, sharpie scissors, small

Wescott

scissors

Bipolar

cautery

Vessel loop

Mosquito

Repair of Penile

Angulation

Perform

erection test if needed

Mark point of maximal curvature

Incise Buck’s fascia

Plicate penis

Close Buck’s fascia

Vessel loop, mosquito,

27g

Butterfly needle and injectable saline

Marking pen

0.3

pickup

x 2 and

Wescott

scissors

5-0

Ethibond

suture

6-0

PDS

suture

Glans

Incision

Mark glans

Make glans incision

Establish hemostasis

Incise plate if desired

Marking pen

0.5

pickup

x 2, 15 blade

scalpel, sharpie scissors

Bipolar cautery

Urethroplasty

First layer of

urethroplasty

Harvest dartos flap

Anchor flap over

anastomosis

0.12

pickup

x

2

7-0 PDS

on

Castro Viejo

driver

Sharpie scissors

6-0

PDS

Glansplasty

Close glans in 2 layers

Re-approximate

mucosal collar

6-0

PDS

Tenotomy

scissors

Skin

Coverage

Release

tourniquet if used

Establish

hemostasis

Raise skin flaps

Tailor and

re-approximate

skin

Bipolar

electrocautery

Marking

pen

Tenotomy scissors

5-0 Monocryl

Dressing

Stitch

traction suture to feeding tube

Wash penis

Apply adhesive

and dressing

French

eye needle

Wets and

drys

Telfa

and

steri

strip,

tegaderm

x 2, scissors,

coban

OR

Table

Surgeon

Assistant

Scrub

Video

Bovie

Back

table

IV Pole

Anesth

Door to OR

Circulator’s Computer

Mayo

Circulator

Foot

Pedal

Patient’s head

Text

Text

Text

Extra

Text

Text Label

Castro Viejo Needle Driver

Weck Spears

Bipolar

Electrocautery with Needle Tip

Mosquito x 2

Gnat x 4

Sharpie

Tenotomy

Wescott

Straight Iris

Adson x 2

0.12 Pickup

0.5 Pickup

Raytec

Marking Pen