OT Resource for K9 Overview of Surgical Procedures

Home , Colectomy, Ileostomy, Pancreatectomy

OT Resource for K9 Overview of surgical procedures

Prepared by: Hannah Woolley Stage Level 1

Gynecology/Oncology Surgeries

Lymphadenectomy (lymph node dissection)

 Surgical removal of lymph nodes

Radical: most/all of the lymph nodes in tumour area are removed Regional: some of the lymph nodes in the tumour area are removed

Omentectomy

 Surgical procedure to remove the omentum (thin abdominal tissue that encases the stomach, large intestine and other abdominal organs)

Indications for omenectomy:  Ovarian cancer  Sometimes performed in combination with TAH/BSO

Posterior Pelvic Exenteration

 Surgical removal of rectum, anus, portion of the large intestine, ovaries, fallopian tubes and uterus (partial or total removal of the vagina may also be indicated)

Indications for pelvic exenteration  Gastrointestinal cancer (bowel, colon, rectal)  Gynecological cancer (cervical, vaginal, ovarian, vulvar)

Radical Cystectomy

 Surgical removal of the whole bladder and proximal lymph nodes  In men, prostate gland is also removed  In women, ovaries and uterus may also be removed

Following surgery:  Urostomy (directs urine through a stoma on the abdomen)  Recto sigmoid pouch/Mainz II pouch (segment of the rectum and sigmoid colon used to provide anal urinary diversion)

Radical Vulvectomy

 Surgical removal of entire vulva (labia, clitoris, vestibule, introitus, urethral meatus, glands/ducts) and surrounding lymph nodes

Indication for radical vulvectomy  Treatment of vulvar cancer (most common)

Sentinel Lymph Node Dissection (SLND)

 Exploratory procedure where the sentinel lymph node is removed and examined to determine if there is lymph node involvement in patients diagnosed with cancer (commonly breast cancer)

Total abdominal hysterectomy/bilateral saplingo-oophorectomy (TAH/BSO)

 Surgical removal of the uterus (including cervix), both fallopian tubes and ovaries

Indications for TAH/BSO:  Uterine fibroids: benign growths in the muscle of the uterus  Endometriosis: condition where uterine tissue grows on structures outside the uterus (i.e. fallopian tubes, ovaries, other pelvic structures)  Abnormal uterine bleeding  Chronic pelvic pain  Endometrial cancer  Gynecologic cancer (vulvar, vaginal, ovarian, cervical)

Hepato-Biliary Surgery

Distal Pancreatectomy

 Surgical removal of the lower half of the pancreas, often accompanied by removal of the spleen (splenectomy) Can be performed openly (one large incision) or laparoscopically (multiple small incisions). Recovery is more rapid with laparoscopic procedure.

Major Hepatectomy

 Resection of four or more liver segments to remove invasive masses or metastases

Pancreaticduodenectomy (Whipple procedure)

 Surgical removal of the head of the pancreas, gallbladder, portion of the duodenum, small portion of the pylorus (part of the stomach), lymph nodes near the pancreas.

Indication for pancreaticduodectomy  Removal of tumours in the pancreas (most common)

Common complication:  Delayed gastric emptying, sometimes resulting in the need for feeding tube post-op

General Surgeries

Appendectomy

 Surgical removal of the appendix

Can be performed openly (one large incision) or laparoscopically (multiple small incisions). Recovery is more rapid with laparoscopic procedure.

Cholecystectomy

 Surgical removal of the gallbladder (often due to gallstones causing pain/infection)

Can be performed openly or laparoscopically. Recovery is more rapid with laparoscopic procedure.

Incisional (Ventral) Hernia Repair

 Surgical repair of a ventral hernia, which appears following incisions made during surgery, most commonly in the middle of the abdomen. The hernia is repaired using synthetic mesh to prevent further damage/recurrence.

Can be performed openly or laparoscopically. Recovery is more rapid with laparoscopic procedure.

Inguinal Hernia Repair

 Surgical repair of inguinal/groin hernia where the weakness in the abdominal wall is repaired and patched with synthetic mesh

Can be performed openly or laparoscopically. Recovery is more rapid with laparoscopic procedure.

Lysis of Adhesions (Adhesiolysis)

 Surgical separation of structures in the abdomen (i.e. scar tissue) following surgery in order to prevent complications Most common complication as a result of adhesions is small bowel obstruction, which can necessitate further surgical interventions

Nephrostomy

 An opening created between the kidney and the skin in order to drain urine in the event of an infection or blockage in the ureter. A nephrostomy tube connects to a pouch that collects the urine on the outside of the body. 6

Colorectal surgeries

Colectomy  Partial or total removal of the colon (large intestine), rectum and/or anus

Can be performed openly (one large incision) or laparoscopically (multiple small incisions). Recovery is more rapid with laparoscopic procedure.

Indications for colectomy:  Rectal cancer  Polyps (growths) in the lining of the colon  Diverticulitis  Inflammatory Bowel Disease  Crohn’s disease  Ulcerative colitis  Uncontrolled bleeding

Hartmann’s Procedure (Proctosigmoidectomy)

 Surgical removal of a portion of the sigmoid colon and/or rectum

Sometimes performed in combination with colostomy if the bowel cannot be re- joined

Indications for Hartmann’s Procedure  Abscess  Diverticular disease  Bowel cancer

Ileo/Colostomy (Colon Resection)

 Ileostomy: surgical procedure where the small intestine is routed outside the body on the abdomen to form a stoma, where a pouch is attached to collect stool. This is often performed in conjunction with colectomy (removal of the colon, rectum and/or anus)

 Colostomy: surgical procedure where the large intestine is routed outside the body on the abdomen to form a stoma, where a pouch is attached to collect stool.

Both procedures can be permanent (long-term) or temporary (short-term)

Useful Terminology

Jackson Pratt (JP) drain: small bulb that uses negative pressure to drain fluid from incision or wound; closed drain that reduces the risk of infection

Commonly seen in:  Radical vulvectomy  Abdominal surgery  Mastectomy  Thoracic surgery

https://www.mskcc.org/cancer-care/patient-education/caring-your-jackson-pratt-drainage-system

Pigtail drain: routes unwanted fluids away from an organ, duct or abscess. Inserted by a radiologist. Commonly seen in:  Nephrostomy  Bile draining  Pleural effusion

https://www.cookmedical.com/products/uro_pigtail025_webds/ 8

Chest tube: drainage system to remove fluid, air or blood from pleural (chest) space

Indicated for:  Haemothorax: collection of blood in pleural space  Pneumothorax: collection of air in pleural space  Chylothorax: collection of fluid in pleural space  Pleural effusion: exudate/transudate in pleural space

Chest tubes can be very sensitive/painful; therefore patients will likely have regular pain medication for management

Drain should never be lifted above chest level, as it relies solely on gravity

http://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Chest_Drain_Management/

Nasogastric (NG) tube: tube that passes through the nostril to the stomach,

Commonly used for:  Feeding (i.e. TPN)

http://www.oxfordmedicaleducation.com/clinical-skills/procedures/nasogastric-ng-tube/

Foley Urinary Catheter: thin flexible tube inserted into the bladder through the urethra, which drains urine into a bag outside the body

http://sterigear.com/the-fig-leaf/

PleurX Catheter: system to drain fluid found in pleural effusion and ascites (excessive build up of fluid in the abdomen)

http://www.sind.si/html/__pleurx_drainage_kit.htm

Double J Stent (Ureteric stent): thin, hollow tube placed in the ureter, creating an unobstructed pathway between the kidney to the bladder

Commonly used:  Kidney stones  Post-operatively to ensure urinary drainage Photo:http://www.kidneystoneclinic.com.au/urinary-tract-double-j.html

Colostomy/Ileostomy pouch: Collects stool from abdominal stoma (large intestine routed outside the body through opening on the abdomen)

Commonly seen in:  Colectomy  Colostomy/Ileostomy

https://www.mskcc.org/cancer-care/patient-education/posterior-pelvic-exenteration

Peripherally Inserted Central Catheter (PICC) Line: Intravenous (IV) tube that remains inserted and protrudes on the outside of the patient’s body so that it is easily accessible for taking blood and providing medication (without having to perform multiple injections)

http://www.macmillan.org.uk/information-and-support/treating/chemotherapy/being-treated-with-chemotherapy/picc-lines.html 11

Normal Values for Vital Signs

Heart Rate (HR): 72 beats/minute

Blood Pressure (BP): 110-140/70-90 mmHg

Respiratory Rate (RR): 12-15/minute

Temperature: 37 degrees Celsius (orally)

Oxygen saturation (SaO2): 92-97%

Works Cited

American Cancer Society. (2014). What is a urostomy?. Retrieved from https://www.cancer.org/treatment/treatments-and-side- effects/physical-side-effects/ostomies/urostomy/what-is-urostomy.html

American Cancer Society. (2017). What is an ileostomy?. Retrieved from https://www.cancer.org/treatment/treatments-and-side- effects/physical-side-effects/ostomies/ileostomy/what-is-ileostomy.html

American College of Obstetricians and Gynecologists. (2015). Hysterectomy. Retrieved from http://www.acog.org/Patients/FAQs/Hysterectomy

American College of Surgeons. (2015). Cholesystectomy: Surgical removal of the gallbladder. Retrieved from https://www.facs.org/~/media/files/education/patient%20ed/cholesys.ashx

Bard Medical Inc. (n.d.). Foley catheter care and maintenance. Retrieved from http://www.bardmedical.com/media/629466/ud_foleycatheterpteducationguide.pdf

BD. (2017). PleurX drainage system. Retrieved from http://www.carefusion.com/our-products/interventional-specialties/drainage/about-the- pleurx-drainage-system/pleurx-drainage-system

Birmingham Bowel Clinic. (2011). Hartmann’s procedure. Retrieved from http://www.birminghambowelclinic.co.uk/treatments-hartmann’s- procedure/

Breastcancer.org. (2016). Sentinel lymph node dissection. Retrieved from http://www.breastcancer.org/treatment/surgery/lymph_node_removal/sentinel_dissection

Cancer Research UK. (2015). Removing the bladder (cystectomy). Retrieved from http://www.cancerresearchuk.org/about-cancer/bladder- cancer/treatment/invasive/surgery/removing-bladder

Centre for Pancreatic and Biliary Diseases. (2002). Distal pancreatectomy. Retrieved fromhttp://www.surgery.usc.edu/divisions/tumor/pancreasdiseases/ web%20pages/pancreas%20resection/distal%20pancreatectomy.html

Centres for Disease Control and Prevention. (2017). Uterine cancer. Retrieved from https://www.cdc.gov/cancer/uterine/

Daley, B. (2015). Open Adhesiolysis. Retrieved from http://emedicine.medscape.com/article/1829778-overview

Kidney Stone Clinic. (n.d.) Uteric stent information double J stent. Retrieved from http://www.kidneystoneclinic.com.au/urinary-tract-double- j.html

Koukounaras, J., Lyon, S. (2016). Nephrostomy. Retrieved from https://www.insideradiology.com.au/nephrostomy/ Memorial Sloan Kettering Cancer Centre. (2017). About your posterior pelvic exenteration surgery. Retrieved from https://www.mskcc.org/cancer-care/patient-education/posterior-pelvic-exenteration

Moffit Cancer Centre. (n.d.). Omentectomy for ovarian cancer. Retrieved from https://moffitt.org/cancers/ovarian-cancer/omentectomy/

National Cancer Institute. (n.d.). Lymphadenectomy. Retrieved from https://www.cancer.gov/publications/dictionaries/cancer- terms?cdrid=45763

Oxford Medical Information. (n.d.). Nasogastric (NG) tube placement. Retrieved from http://www.oxfordmedicaleducation.com/clinical- skills/procedures/nasogastric-ng-tube/

Pancreatic Cancer Action Network. (n.d.). Whipple procedure (pancreaticduodenectomy). Retrieved from https://www.pancan.org/facing- pancreatic-cancer/treatment/surgery/whipple-procedure-pancreaticoduodenectomy/

Reddy, S. K., Barbas, A. S., Turley, R. S., Steel, J. L., Tsung, A., Marsh, J. W., & Clary, B. M. (2011). A standard definition of major hepatectomy: resection of four or more liver segments. HPB, 13(7), 494-502. Retrieved from http://onlinelibrary.wiley.com/doi/10.1111/j.1477-2574.2011.00330.x/full

Royal Children’s Hospital Melbourne. (2016). Chest drain management. Retrieved from http://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Chest_Drain_Management/

Smith, L. (2015). Surgical treatments: vulvectomy. Retrieved from https://www.oncolink.org/cancers/gynecologic/vulvar-cancer/surgical- treatments-vulvectomy Society of American Gastrointestinal and Endoscopic Surgeons. (2015).

Laparoscopic inguinal hernia repair surgery patient information from SAGES. Retrieved from https://www.sages.org/publications/patient- information/patient-information-for-laparoscopic-inguinal-hernia-repair-from-sages/

University of California Department of Surgery. (2016). Ventral (incisional) hernia. Retrieved from http://surgery.ucsf.edu/conditions-- procedures/ventral-(incisional)-hernia.aspx

University of Chicago Medicine. (n.d.). Frequently asked questions about colectomy (colon resection). Retrieved from http://www.uchospitals.edu/specialties/colorectal/services/colectomy.html#P13_569