Thyroidectomy Set Up

This set up is what I use for almost all ENT procedures on the neck. I use this for neck dissections, parathyroidectomy, thyroidectomy, lymph node dissection, and any other similar procedure. This is one of my favorite set ups and procedures, of course an ex lap is right up there too.

Back Table Set Up Thryoidectomy

Here is a look at the back table. I prefer to condense my instruments versus spread them out, mainly because I have short arms and don’t want to have to step off of the step stool to reach what I need! This specific set up was for a thyroidectomy; Starting on the left side of the table I place my instrument tray and lay my retractors along the back lip for easy grabbing. This specific pan contains a trach hook and spreader, which is not needed or this, so I put it under those retractors along with the 2nd (not-preferred) bipolar forcep. Next is my pitcher with an asepto for irrigation prior to closure. Next I lay the two pairs of scissors that are rarely used right next to the remaining clamps that are not placed the mayo stand. I set up like this every single time, so I truly could reach for most of these things without looking. Keeping a routine with your setup is huge in being an efficient scrub. My pick ups are hung on the front lip of the pan and the additional needle drivers are propped up on the front right corner. It’s hard to see this picture, but I put my telfa (to put the specimen on) on the very far left between the first retractors and the left side of the tray.

Neck Pan Left to Right

Cushing vein retractor (2), Senn retractor (2), Volkman Rake retractor (2), Army-Navy retractor (2), 3/4” Richardson retractor (1), Trach spreader (dilator), trach hook, bipolar forcep below

Pitcher with asepto, curved Mayo scissors, Straight Mayo scissors, Mosquito clamp (4), Kelly clamp (4), Allis clamp (2), Babcock clamp (2), Jacobsen (Jake) clamp (2), Lahey clamp (2)

Tissue Forceps on front lip left to right

Brown-Adson tissue forcep (2), Debakey tissue forcep, Rat Tooth forcep, Russian tissue forcep

Sharps & Smalls

Needle board- ruler slid below, non-guarded bovie tip in #31, dermahook with suture bootie in #32 (usually there are two here, however I dropped one when preparing them), board which will be for bactroban at the end of the procedure, suture bootie foam, Needle Drivers laying up front for easy grabs.

Suture- 3-0 silk SH for tagging specimen, if drain add second 3-0 silk. Ensure you do not use the same suture to tag the specimen to secure the drain to prevent malignant cells spreading. 3-0 Vicryl SH control release (pop-offs) to suture first layer. Then a 3-0 Vicryl SH swedged for the runner (not pictured because I forgot to open!). Lastly a 4-0 Vicryl PS-2 for skin closure.

4 Peons with Dermahooks for retraction. We add suture booties so the end of the hook doesn’t get caught or snagged on during the procedure. I place these on a roll for easy grabbing, they are one of the first few steps in the procedure and I pull them up to my mayo immediately before- I don’t like to keep these on my mayo stand.

INTRAOPERATIVE TIP

INTRAOPERATIVE TIP

Avoid laying dermahooks directly on the back table, elevate them with some sort of roll. This prevents them from snagging your back table and causing a contamination.

INTRAOPERATIVE TIP

INTRAOPERATIVE TIP

Beside the instrument pan is a basin and kidney basin. I throw the ‘extras’ (med cup, labels) in the kidney basin. Then I place my laps in the round basin with the additional raytecs on top. I open 20 total raytecs for a Thyroidectomy and by the time its time to count we’ve gone through most if not all of them and I have just laps remaining in the basin- which is better for counting. Then at the far right of the table are extra towels and gown and gloves for those scrubbing in.

Not pictured: Ring stand basin with drapes and things to throw off the field.

Basin from top to bottom- harmonic scalpel, bipolar forcep and cord, nerve stimulator, bovie, suction, laparotomy drape (without troughs), 4 flat towels, 2 scrunch towels. Then I slide a ring forcep in the side to secure all of the cords. I am a movie holster hanger- I hang in on my mayo and pop the bovie in it, I also put the nerve stimulator in the holster. The bipolar forcep gets laid on the mayo between the scissors and the clamps. The harmonic is placed on the drapes between the surgeon and the mayo stand- it’s used pretty frequently in a Thyroidectomy.

Thyroidectomy Mayo Stand

Top left down:

Peanuts- I keep the whole rack up because we use a lot of them. **Peanuts are used for blunt dissection.

Large clip appliers with rack Small clip appliers with rack

Richardson Retractor, Greene Loop retractor

Top right down:

Skin Marker, # 10 blade, #15 blade, Adson tissue forcep (2), Debakey tissue forcep, Litler scissors, Curved Metzenbaum scissors, Tenotomy scissors, Straight Metzenbaum scissors

After we drape the bipolar forceps will be placed here.

Instrument Roll left to right

Double prong skin hooks- these are used in the first few steps of the procedure then replaced by Dermahooks, after these are used I move them to my back table.

Right angle, Jake, Allis (2), Kelly (2)

*I like to put these on a rolled up lap sponge. This is done AFTER counting. I only put a few instruments on this ‘baby’ roll, so an actual towel is a little too much and they don’t stay in place. This works perfectly as it has a little bit of ‘give’ to it.