Basic Instrument Use Supervised Laboratory Activities

Student Name:

Date:

Introduction

In this hands-on laboratory, you will practice a series of basic instrument handling skills using , thumb , and . The mastery of these core basic skills will provide you with the skills necessary to perform most soft tissue surgeries encountered in practice.

During this lab, take advantage of practicing your surgical skills in a safe, controlled environment. Take your time practicing each skill, and don’t move on to the next skill until you are confident with your technique and have demonstrated it to the instructor. Remember, the instructor is there to provide you with valuable feedback to help you refine your surgical skills. SESSION 1: SKILLS

Equipment and Supplies

Each student should have the following supplies:

• #3 Scalpel handle • #15 Blade • #10 Blade • Needle holders • Marker • Cadaver (shared among 1-2 partners)

Preparation

Clip the entire lateral aspect of the cadaver from the neck to the tail and the entire ventral abdominal wall. Place the cadaver in lateral recumbency and fix to the table using rope ties.

Techniques to Practice

Arming and disarming a scalpel With a #3 scalpel handle and a #10 blade, arm and disarm a scalpel handle multiple times using the needle holders.

Passing and receiving a scalpel Practice safely passing the scalpel back and forth to your partner multiple times, demonstrating the proper technique.

Pencil grip and slide cut With your marker, draw a quarter-sized lesion on your cadaver skin. With a #15 scalpel blade, grasp the scalpel in the pencil grip and remove the outlined skin, demonstrating a slide cut.

Fingertip grip and slide cut With your marker, draw several straight and curvilinear 5-7 inch long lines on the cadaver trunk. With a #10 blade, grasp the scalpel in the fingertip grip and create skin incisions along the lines, demonstrating a slide cut technique.

Performing a good skin incision With a #10 blade, grasp the scalpel in the fingertip grip and create a long skin incision using a slide cut technique. During the skin incision, demonstrate the ability to complete the incision with one scalpel pass, and with consistent depth through the hypodermis.

Press cut Invert a #15 scalpel blade and produce several well-controlled press cuts through the skin. SESSION 2: THUMB FORCEPS AND SCISSOR SKILLS

Equipment and Supplies

Each student should have the following supplies:

• #3 Scalpel handle • • #10 Scalpel blade • Mayo scissors (curved) • Brown Adson thumb forceps • Marker • Adson thumb forceps • Cadaver (shared among 1-2 partners)

Techniques to Practice

Fingertip grip and slide cut With the marker, draw a line from the dorsal aspect of the scapula to the acromion. With a #10 blade, grasp the scalpel in the fingertip grip and make a skin incision along the line into the hypodermis, demonstrating a slide cut technique. Continue the incision through the subcutaneous tissues over the scapula using the same technique and grip on the scalpel.

Passing curved scissors Practice passing the curved scissors back and forth to your partner multiple times, demonstrating the proper technique for handing off curved instruments to the surgeon.

Gripping thumb forceps Grasp the thumb forceps in the modified pencil grip and demonstrate how to maneuver between the “stowed” and “use” positions.

Posture Demonstrate the proper posture and arm position while using scissors and thumb forceps. Use Metzenbaum scissors and Brown Adson thumb forceps to bluntly and sharply dissect the subcutaneous tissue from the scapular muscle in order to expose the scapular muscle.

Sharp and blunt scissor dissection With the muscle and scapular spine exposed, use the Metzenbaum scissors, held in the tripod grip, to bluntly and sharply dissect (scissors cut and push cut) subcutaneous tissue from the entire scapular face. When performing this dissection, be sure to stay parallel to the scapular face in order to avoid inadvertent dissection into muscles overlying the scapula.

Identify the omotransversarius and trapezius muscles attaching to the cranial aspect of the scapular spine. Pick up the fascia just ventral to the margin of the omotransversarius muscle with the Brown Adson thumb forceps. Lift this fascia with the thumb forceps and make a scissors cut just ventral to the omotransversarius muscle. Bluntly undermine beneath this muscle with your scissors. Continue to bluntly undermine beneath the trapezius muscle in a dorsal direction.

Use Metzenbaum scissors and Brown Adson thumb forceps to sharply cut muscle from a bony attachment.

After undermining the omotransversarius and trapezius muscles from the scapula, identify the attachments of these muscles to the scapular spine. Using a scissors cut technique, sharply cut these attachments from the spine with Metzenbaum scissors. Assist this sharp cutting by judicious use of your thumb forceps. SESSION 3: APPROACHING AND ENTERING THE ABOMINAL CAVITY THROUGH A MIDLINE APPROACH

Equipment and Supplies

Each student should have the following supplies:

• #3 Scalpel handle • Metzenbaum scissors • #10 Scalpel blade • Mayo scissors • Adson thumb forceps • Cadaver (shared among 1-2 partners)

Preparation

Place your cadaver in dorsal recumbency and tie the limbs down to the table. For this exercise, if two students are assigned to one cadaver, one student can perform the stab incision and the push cut to open the abdomen, while the other student can perform the push cut to remove the falciform ligament.

Techniques to Practice

Palpating landmarks for a skin incision Palpate the xiphoid cartilage at the cranial aspect of the abdominal cavity, and locate the umbilical scar.

Proper skin incision Using a #10 blade, create a skin incision between the xiphoid cartilage and umbilical scar, with the slide cut technique and a fingertip grip.

Continue sharp dissection of the subcutaneous tissue directly down to (but not through) the linea alba, using the slide cut technique and a fingertip grip.

Press cut In the region immediately adjacent to your intended stab incision site, aggressively lift the abdominal wall upwards and away from the viscera with the Adson thumb forceps. Use an inverted #10 blade in a pencil grip to create a stab (press cut) incision in the middle of the linea alba, between the xiphoid and umbilicus landmarks.

Scissors cut and push cut Using Mayo scissors, open the linea incision with a scissors cut just far enough to be able to palpate the ventral abdominal wall for adhesions.

Using Mayo scissors, open the linea from the xiphoid cartilage to the umbilicus, practicing both push-cut and scissor cut techniques. Begin at the original abdominal wall opening and cut from right to left, up to the level of the xiphoid. Then work from left to right, down to the level of the umbilicus. The abdominal approach has now been completed.

Grasp the falciform ligament with thumb forceps at its caudal most aspect, and use Metzenbaum scissors to sharply incise this tissue away from one side of the abdominal wall opening/fascia. Also demonstrate a push cut technique with the Metzenbaum scissors.