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Planning work in the operating theatre

"The devil is in the details" - that's how you should approach any case. Especially when it comes to a person's health and life. In other words: in every case, there are many nuances, without which the task often becomes extremely difficult and sometimes impossible. Just as every theatre starts with a hanger, work in the operating theatre starts with proper organisation and ergonomics.

I will not detail the importance of asepsis and antisepsis or dwell on issues of sterility in the operating theatre. This is a dogma of any operation. In this section, I would like to focus on the personnel and technique set-up that we feel is most convenient for performing gynaecological operations. I would also like to describe the standard set of instruments that we use in everyday practice.

Hysteroscopy

The surgical team consists of: surgeon (1), operating nurse (4), anaesthetist (3), nurse anaesthetist, nurse aide. The operating table is placed to the left of the surgeon. A monitor located on the right side is used to visualise the operation. The operating nurse is placed to the right of the surgeon. The functions of the operating nurse include fixing the clamp placed on the cervix and assisting the surgeon during the operation.

Laparoscopy

The surgical team for most operations includes: surgeon (1), one assistant (2), operating nurse (4), anaesthetist (3), nurse anaesthetist, nurse aide. In some cases a second assistant (5) is needed when there is a need for additional access from the vaginal side. The role of the 2nd assistant is played by a doctor or a second operating nurse.

The presence of a second monitor in the operating theatre is crucial for ergonomics and comfort, as the surgeon and assistant face each other during the operation.

The first and main access to the abdomen is through a puncture above the umbilicus. A trocar is inserted through this puncture into the abdominal cavity, the carbon dioxide supply is connected and the laparoscope is inserted. I do not use the Veresch needle for insufflation (creating a pneumoperitoneum) in my practice, but use a standard trocar for entering the abdominal cavity, considering this technique safer and more reliable.



Additional punctures 2 are made in the non-vascular areas of the hypogastric region, 1.5-2 cm inwards and downwards from the anterior superior iliac spine (spina iliaca anterior superior). If a 4th puncture is necessary, it is standardly applied along the midline of the abdomen.