We did two Abdominal Hysterectomies today. It was similar to doing them at home, only with a random assortment of poorly functioning instruments, and minimal retractors and no cautery or suction (which usually just annoy me with noise and smell more than they help anyway). For most of the first case, my hand was the bowel retractor.
The Ob/Gyn department has its own small OR, which is called the Gynae Operating Theatre (OT). It is a short distance from the obstetrics ward, and both the Caesars and the Gyn surgeries are done here, which means that the elective Gyn surgeries are usually bumped for the emergent cesarean sections. Today we were lucky in that Sarah, the anesthetist, was willing to run two rooms simultaneously.
The OT is a freestanding structure, and as soon as you enter the outer door, you remove your shoes and put on clogs that remain in the OT. There is a small foyer with a desk for writing operative notes. Through a second doorway is the central area. There is a small changing room, with scrubs available, and you leave your clothes in there (but not the valuables). You then change from the clogs into big rubber boots.
The central area is where the patients are wheeled after the surgery to recover for half an hour (or less). There are 2 stretchers there. The two theatres open off of that area, equipped with an operating table, low-tech monitors (blood pressure, pulse, oxygen saturation). I’m not sure if they are equipped for general anesthesia.
Scrubbing involves taking a piece of apricot-colored hand soap, soaping up all the way to your elbows, and then rinsing off. Sometimes you drop the slippery soap into the drain, so you pick it up and keep scrubbing.
Gowns, caps and masks are all cloth and reused. You gown and glove yourself – there is no scrub nurse or tech. You set up the instruments on the mayo stand, prep the patient with Chlorhexidine solution, and drape with a large cloth drape.
There is no such thing as staples. For closure, you use chromic catgut on the uterus and the peritoneum, then Nylon on the fascia (here it is called the “rectus” which is really confusing) and interrupted vertical mattress sutures of Nylon on the skin. You can do an entire cesarean with only 2 sutures. The Nylon, I am told, doesn’t dissolve. You remove it from the skin, of course, but it stays in the fascia, and often women have pain and irritation for a long time postoperatively from the Nylon in the fascia. They used to use chromic, but had too many incisional hernias, and Vicryl is just too expensive.