Introduction
The operation for open removal of appendicitis requires at least two people to complete it – a surgeon and his technical assistant. The surgeon’s responsibility lies in good command and leadership. The surgical technician is busy checking all equipment to ensure they are functioning properly to avoid technical problems during the operation. The technologist is also responsible for the cleanliness of all instruments and their complete sterility. In parallel with this, they can play the role of a medical assistant, that is, contribute to the correct course of the operation (Vallbohmer et al., 2020). It is important that the surgical technician is subordinate to the surgeon and must follow their instructions unquestioningly (Goras et al., 2020). Reaction speed and professional knowledge of the equipment are the foundation of this profession. The surgeon must rely on the absolute sterility of the room and instruments, ideal lighting for the operation, and complete reliability of all technical equipment.
The Procedure of an Operation
Open appendectomy is performed in case of urgent and direct surgical intervention and takes place in several stages. First, the external space is disinfected. Wipe the skin with an alcohol-iodine solution. Next, anesthesia is introduced, which can be private and administered subcutaneously, affecting all the necessary tissues in the operation area. In more severe cases, general anesthesia is given through a breathing tube (Rajbhandari et al., 2020). At the end of anesthesia, the abdominal cavity is opened with a 10 cm oblique incision in the right iliac part. Throughout the incision, the aponeurosis is exfoliated from the external oblique muscle of the abdomen with Cooper scissors. The fibers of the oblique and transverse muscles of the anterior abdominal wall are moved apart and fixed. The edges of the wound are parted with hooks, then the surgeon opens the peritoneum with anatomical forceps.
Then the surgeon’s task is to locate the cecum, grab its dome and pull the wound outward along with the appendix. A hemostatic clamp is applied to the mesentery of the appendix and novocaine is injected into it. The task of the surgeon is to tighten with a clamp and remove the painful process, after which the abdominal cavity is checked for problems. Periodically, the doctor needs the assistance of another surgeon or nurse. The surgeon needs a second hand to expand the abdominal cavity when opening it, holding the cecum while extracting it, and removing the inflamed process. Also, the help of a nurse is needed when cutting off the ligature tissue in the process of suturing the wound. At the very end of the operation, a bandage or adhesive is applied to the patient. After this, the assistant must pass the removed process for histological analysis to identify the cause of the inflammation.
The Required Instruments
Of the necessary instruments required by the surgeon to complete the operation, two types of scalpels are needed, abdominal and pointed (Okereke et al., 2019). A garment clip is also needed to grip and hold the garment on the patient. The surgeon needs abdominal mirrors positioned in such a way as to have complete control throughout the operation (Vanover & Saadai, 2019). The abdominal scalpel is used to dissect the fatty tissues of the skin and subcutaneous tissue. A pointed scalpel is needed to incise the aponeurosis of the abdominal muscle tissue. Cooper scissors with one sharp end is required for dissection of abdominal tissue and aponeurosis. Surgical and anatomical tweezers help in grasping, holding, and stretching skin and muscle tissues, as well as for pulling the parietal peritoneum into the wound (Pakarinen, 2020). Farabef lamellar hooks are required to separate the edges of the wound.
Clamps of different types are also required for different functions. A direct Billroth forceps is necessary to stop bleeding from transected vessels and to hold the appendix by its mesentery during its removal. A curved clamp is required to grasp and hold the parietal peritoneal tissue against the drape. The curved “Mosquito” -type forceps pierces the mesentery of the appendix and allows the ligature to be passed through its tissues while suturing the wound. The absorbable and non-absorbable suture material is used to suture a wound and stop bleeding from the vessels of the anterior abdominal wall (Chen & Wang, 2019). The presence of blood in the abdomen is checked with a gauze bandage. Muscle and abdominal wounds are stitched with catgut stitches. Silk or catgut interrupted sutures are placed on the aponeurosis of the external oblique muscle. The skin is sutured with separate interrupted silk sutures. Also, for suturing the wound, Deschamp’s piercing curved surgical ligature needles are required. In the case of extreme and destructive forms of appendicitis, it may also be necessary to drain the abdominal cavity, which can be provided using a special drainage tube (Li et al., 2018).
Conclusion
The ideal universal strategy for the treatment of inflammation of the appendix remains open in the medical community. The contradictions between open acute surgery and less intrusive forms of therapy are still the subject of active discussion (Horvath et al., 2017). However, it is safe to say that in the case of acute inflammation, the question of an urgent need for surgical intervention may arise (Athanasiou et al., 2017). In this situation, the surgeon and his assistants must act with all the technical supplies, be ready to act together and take into account the subordination, and maintain stress resistance psychologically and complete sterility externally.
References
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