Surgeon Name: HYPOSPADIAS OR Protocols Template for: HYPOSPADIAS There are explanations of each template - how it will look when finished and how to correctly.

Surgeon Name:

OR Protocols Template for: HYPOSPADIAS

There are explanations of each template - how it will look when

finished and how to correctly complete each template. Please fill

each section out and return to [email protected]

1. OR Checklists

2. Procedure Sequence Guide

3. Room Arrangement

4. Instrument Labels

Byron Joyner, MD, MPA

Surgeon Name:

Glove Size:

OR Protocols - General Checklist

Please use the line shape below to cross out items on the example checklist that you do not wish to have included on your personal checklist.

If you wish to add additional items not listed here, please use the following slides to add them to the appropriate section.

Copy, paste and move this line as many times as required.

Byron Joyner, MD, MPA

7.5 Sensicare

Done N/A

1. Pre-Flight (Preparations) ChecklistPlease add any items you wish to include on your list.General: For All Cases

Anesthetic plan established, type of regional block

Preoperative antibiotics established

Fellow or resident participating in case established

Pagers removed from self and placed on counter

Site marked

Time out performed

Sutures: 4-0 PDS on ann RB1, 5-0 Monocryl on a P3

Dressing: Dermabond

Done N/A

Please add any items you wish to include on your list.2. In-Flight (Procedure) ChecklistGeneral: For All Cases

Done N/A

Please add any items you wish to include on your list.

Done N/A

Done N/A

NEXT Case Preparations:

THIS Case Preparations:

3. Landing (Post-Procedure) ChecklistGeneral: For All Cases

Determine location of next patient

Need for H/P or consent of next patient

Safety sign out performed

Parents notified

PACU orders written

Postoperative antibiotics and pain medication plan established

Postoperative orders written

Disposition established

Equipment issues

Improvements

Surgeon Name:

Procedure:

Glove Size:

OR Protocols – Procedure Checklist

Please use the line shape below to cross out items on the example checklist that you do not wish to have included on your personal checklist.

If you wish to add additional items not listed here, please use the following slides to add them to the appropriate section.

Copy, paste and move this line as many times as required.

Hypospadias

Byron Joyner, MD, MPA

7.5 Sensicare

Done N/A

1. Pre-Flight (Preparations) ChecklistPlease add any items you wish to include on your list.Hypospadias-Specific

Sutures: 4-0 pds on RB1 , 5-0 monocryl on P3

Needle tip on bovie electrocautery

Done N/A

Please add any items you wish to include on your list.2. In-Flight (Procedure) ChecklistHypospadias-Specific

Done N/A

Please add any items you wish to include on your list.

Done N/A

Done N/A

NEXT Case Preparations:

THIS Case Preparations:

3. Landing (Post-Procedure) ChecklistHypospadias-Specific

OR Protocols – Procedure Sequence Guide

Here is an example of the procedure sequence guide. It contains components and steps for each part of the surgery. The 3rd column lets the nurse or scrub tech know what instrument to have ready.

Please use the following slides to create your procedure sequence guide with the specifics of how you perform the surgery.

Components Steps Instruments / Scrub Tech

Surgical Procedure: HYPOSPADIAS

Mark Incision 1. Mark 2 cm incision along Langerhans lines 1 finger breadth medial to ASIS and 1 finger lateral to semi-lunaris

1. Marking pen2. Raytec

Incision and Dissection 1. Make incision at skin2. Incise dermis with electrocautery3. Use Jake clamp to dissect through

Scarpa’s fascia 4. Divide Scarpa’s and develop plane to

external oblique fascia5. Define shelving edge and superficial

inguinal ring

1. 15 blade scalpel2. Adson x 23. Jake4. Electrocautery with needle tip5. S retractors x 2

Open Fascia and Expose Cord 1. Place right angle in external ring2. Incise external ring and reposition clamp

superficially3. Incise fascia proximally4. Sweep nerve off fascia and transpose5. Separate cremasteric fibers

1. Right angle clamp2. Electrocautery3. Debakey forceps x 24. Mosquito

Dissect Out Hernia Sac and Ligate

1. Deliver entire sac with cord out of incision

2. Identify and isolate hernia sac3. Identify spermatic cord vessels and vas

deferens4. Dissect hernia sac off cord proximally5. Suture ligate hernia sac and place

second tie proximal to suture

1. Debakey forceps x 22. Mosquito clamp3. Raytec4. Straight snap x 25. Tenotomy scissors6. 4-0 PDS

Close Fascia and skin 1. Close external oblique fascia2. Close Scarpa’s fascia3. Close skin 4. Pull on testicle

1. 4-0 PDS2. Debakey forceps3. 5-0 Monocryl4. Adson forceps x 25. Mastisol, steri strips, Oasis dressing,

Tegaderm

Components Steps Instruments / Scrub Tech

Components Steps Instruments / Scrub Tech

OR Protocols – Room Arrangement

This section shows how the room should be arranged for each procedure and where each staff member generally stands.

On the following slide, move the objects around to position them correctly for your hypospadias procedure. If you need more objects, simply copy and paste one, then double click the text to change the name of the item.

IV Pole

Foot Pedal

Room Arrangement:Hypospadias

Please use the shapes below as shortcuts for any new items.

OR Table

Surgeon

Assistant

Scrub

Video Bovie

Back table

IV Pole

Anesth

Door to OR

Circulator’s Computer

Mayo

Circulator

FootPedal

Patient’s headText

Text

Text

ExtraText

OR Protocols – Instrument Labels

This section shows how to correctly set up the mayo stand or back table. It also shows the names of each instrument so that mistakes are avoided.

On the following slide, please insert your own photo of your mayo stand or back table.

Then use the blank labels to type in the correct names and position the labels appropriately.

Mayo Stand | Hypospadias

Copy/Paste to re-use. The shape will change to fit the amount of text. Text Label

Metzenbaum (2)

Debakey (4)Adson (2)

Mosquito, Straight Snap,

Right Angle

Jake

Bipolar

Electrocautery with Needle Tip

Raytec

S Retractor (2)

Peanut on Curved

Hemostats (2) Light Handles