How To Build A Small Wooden Swingset

Mary, 51 years

of prov. Bergamo

"live as challenging

daily Sla"

editorial @ Bergamonews

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File di prova

E 'can be downloaded and viewed a small test file to see some of the contents of the book "Tools of the Operating Room.
You can download it from this URL

would be important for me to have your opinion and a review, possibly with an e- mail (borgio3@supereva.it).

Thanks :-)

Skin Moles Condition_symptoms

Enucleazione di neoplasia renale

patient about 65 years of medium build, diabetic. exophytic lesion presents the renal surface approximately midway between the two poles of the kidneys.

The project consisted of enucleation surgery, laparotomy, the tumor also involving the kidney fat adjacent to the tumor.

Container

• Base per interventi chirurgici maggiori
• Divaricatore Omni Track
• Strumentario per chirurgia vascolare

Teleria

• Set per l'allestimento di un campo quadrangolare comprendente l'intera estensione addominale ed i fianchi della paziente

Fili di Sutura e Lame

• Lama da 20 per la laparotomia e da 10 per l'eventuale resezione della neoplasia
• Intrecciato, riassorbibile USP 1 per chiusura laparotomia
• Monofilamento, assorbibile, atraumatico USP 3/0 con ago 26 mm. per sutura della braccia renale a fini emostatici
• Filo per il fissaggio del drenaggio
• Prolene 4/0 August 22 to suture vascular

Garrison

• full vacuum

bed and supine positions

• right arm abducted to arterial and venous access
• bladder catheterization, CVC and SNG to be removed at the end of intervention
Description of

1. engraving xipho sottombelicale
2. -positioning retractor OmniTract (four valve wall plus a wide spatula to displacement of the coil ileal and spleen) in a single block
3. mobilization of the spleen, the splenic flexure of the colon and the pancreatic tail (Mattox maneuver) with Ligasure, bipolar, anatomical long, pad mounted and clamp ring
4. palpation of the lesion for localization
5. Opening of the renal capsule and perirenal fat and creating windows of access to the lesion, with bipolar, long
6. anatomical engraving with perilesional electric scalpel about 2 cm from the lesion.
7. Application of hemostatic sutures, and completion of the enucleation of the lesion with electric cautery and bipolar
8. Careful hemostasis of the renal breccia and application of pressure point on the edges of the excision
9. washing the peritoneal cavity with warm saline groundwater
10. Application of TachoSil (hemostatic) and shrink the gap kidney.
11. Positioning drainage laminar split into left renal loggia and its mounting
12. count of instrument and the closure of access garzame
13. (fascia and muscle)

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Emicolectomia e Nefrectomia destre

patient 59 years old, medium build, 80 Kg weight around. Good condition.
tumor of the right colon at the hepatic flexure and cancer of the right kidney. A number of lymph node metastases.

The operating table was to make the first right hemicolectomy, enclosing the surgical specimen in a endobag, before moving to the right nephrectomy, removing both anatomical parts and then proceed to the ileo-colic anastomosis latero-lateral, all in laparoscopic.

• Container Container Container
• standard laparoscopic conversion laprotomica

Instruments extra

• Thermos
• needle holder
• clipper + video clip big Haemo-lock

Wire Suture & Blades

• Lama 10 x 20 x 1 and 1 for open-access laparoscopy and laparotomy pubic service
• atraumatic braided absorbable 3 / 0 for anastomosis and closing the gap peritoneal
• 0 monofilament absorbable August 26 suprapubic laparotomy for closure of the peritoneum
• braided absorbable atraumatic Aho 0 5 / 8 x 3 for closing the laparotomy
• range of skin-absorbable 3 / 0

• Endo GIA staplers Covidien + Refills endogenous 45 and 60 Blue section of colon anastomosis and packaging
• Refills White 30 mm. vascular section of the renal vein

Garrison

• Trocar 10 x 2 + 1 spindle
• Trocar 5 x 2 + 1 spindle
• Covidien Trocar 15 mm. dell'endobag big step for
• Copritelecamera
• Ligasure 5
• September disposable suction pump for irrigation + Cable MTP
• bag from washing 2000 ml.
• 500-ml bag of saline with 10 ml of Poviderm
• laminar Drainage + bag collection

bed and Positions

• lithotomy position with a thickness on the right side of the patient to highlight the lumbar
• initial horizontal leveling then progressive moderate left lateralization
• right arm abducted to venous access
• Cushion Pak Vac Vacuum and patient positioned on the extreme left edge of the bed
• Monitor places the head and right side of the patient. Touchscreen instrument side cover with a sterile operation of cameras, recordings and accessories from room
• Three surgeons at the patient's left, for the time colic, operator between the legs for the time renal
• Instrument and anastomotic end of the lower right

Description of variables and

1. Positioning of trocars: 10 umbilical, 10 in left hypochondriac region, 5 in the left lower quadrant, 5 in the right hypochondriac region
2. Exploring the repertoire of the cavity and marked with the tumor, with two
3. Johannes Treitz and Repertoire of the loop of the repertoire of vascular elements with Ligasure and Johanne (before patch)
4. Chamber of vascular elements with Clips violet (photo) Ligasure and (photo)
5. Given the many lymph node metastases present, the surgeon proceeded to dissect the first transverse colon (endogenous Covidien with charging 60 Blue) and then managed to unplugged the hepatic flexure of the colon and to effect the posting of the same shower right parieto-colic. All with bipolar Ligasure (second patch)
6. section of the loop ileostomy to about 2 cm from the ileocecal valve with charging 60 with endogenous Covidien Blu
7. placement of suprapubic trocar Covidien 15 mm. dell'endobag and introduction of 15 mm. Insertion of the same anatomical part and its repositioning in the right iliac fossa of the right ureter
8. Search with Ligasure Bipolar and, to be used as a marker for the detection of vascular elements (right renal artery and vein)
9. Section ureter after application of clips Haemo-Lock 10 mm. and section with Ligasure
10. vsscolari Identification of the elements. Section on the left main renal artery, with the use of Haemo-Lock Clips 10 mm. and section with Ligasure.
    The renal vein was conspicuous dimensions so that, after her finding with Vesseloop set with red clip, the surgeon has dissected with endogenous Covidien charging with 30 mm vascular.
11. Isolation and mobilization of the right kidney with perirenal fat and capsule, with Ligasure, Johanne and Bipolar
12. Inserting new EndoBag large and "capture" of the kidney.
13. Minilaparatomia suprapubic and extraction of the two anatomical parts with the help of pliers ring
14. single layer closure of the peritoneal (0 monofilament absorbable August 26) of minilaparatomia
15. Recovery Room and peritoneal removal of the gauze.
    During the operation one of these Garzino (from 7.5 mm x 7.5 mm) has migrated into the region left parieto-colic, managing to disguise themselves.
    The ability of these principals to take very small and apparently migrate into regions not affected by abdominal surgical operations - per share of flows abdominal surgical actions and the repositioning of the patient - must insist on the maintenance a high level of attention.
    After a thorough search, has been removed. Be careful!
16. Packaging ileo-colic anastomosis latero-lateral
    1. Application of first countertraction
    2. Inserting gauze Poviderm
    3. Execution of two Tomie - with scissors - on the ileal and colonic loops for introduction of the stapler
    4. Insertion of the stapler (Covidien with endogenous charging Blue 45 mm.) packaging and the anastomosis
    5. extraction and control of haemostasis endoluminal stapler
    6. Closing the gap with anastomotic points braided absorbable 3 / 0 Aug. 26 mm. length of about 18 cm.
17. hemostasis control, peritoneal toilet, laminar positioning of drainage in the right renal loggia
18. count of instruments and garzame
19. Removing trocars and closing of the accesses.

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Protesi per Ernie e Laparoceli

are very many other action taken for the repair of abdominal wall defects, iatrogenic origin or not.
Whatever the intervention to be performed and whatever the technique used, the instrument should first carefully read the leaflet of the prosthesis that will be used and to know the following:

1. Type of prosthesis

• Absorbable , partially absorbable, nonabsorbable
  assorbibilisi prosthesis in use or you can use wire crimps or absorbable. In the partially absorbable and nonabsorbable implants are used wire crimps or not absorbable.
  absorbable implants may need to be subjected to immersion in a specific solution for better handling and adaptation to the surface.
• Transparent, Opaque
  transparent implants allow the surgeon to better control the positioning of the prosthesis to the defect to be corrected, which can not happen with those opaque. Typically, the transparent part of a substance is absorbed long stay.
• Shaped ,
  non-shaped implants can be shaped for application to specific laterality (in laparoscopic inguinal hernia) or have a form for which you can direct them as needed (prosthesis with ellipsoidal shape where you can exploit the larger diameter and smaller).
  implants shaped and unshaped not be used as the manufacturer and can not be cut. Those can be shaped to be adjusted before and during the placement and fixation.
• Double surface, surface Mono
  double surface implants are typically equipped with a porous surface / cross-linked be applied to the fascial surface of the abdominal wall and a smooth and soft as to leave contact with the bowel loops.
  The smooth surface should always be kept intact and must be properly identified especially if the implant is transparent or translucent. The porous surface
  / crosslinked strongly stimulates the scarring process and production of fibrous tissue. For this reason, the malposition should be avoided at all costs for which the reticulated surface is in contact with the abdominal viscera. This could cause very dangerous phenomena adhesions.
  monostructural implants, both surfaces have cured, and then impossible to leave contact with the intenstinali alliances. Pears to be applied to the inner surface of the abdominal wall must be inserted into a peritoneal pocket, so that the loops do not come into contact with the prosthesis. The tool then must prepare the tools for the creation of the pocket and its closure after setting of the prosthesis.
• be shaped, unshaped
  non-shaped implants can not be upgraded and should be useful choices in size to cover the defect.
  be shaped implants can be cut to be adapted to specific locations. The prosthesis should not be shaped cut with thermal devices, but with very sharp scissors. The waste must be removed immediately from field to avoid an accidental retention.
• Synthetic, Biological
  synthetic prostheses are those with the greatest use because of the relatively low cost and the almost total anallergenicità. Those are intended to more fully integrate biological tissue as possible. The former do not require special treatment prior to their placement, while the second is often accompanied by pre-treatment necessary so that they can be adapted and positioned to the fullest. Generally, biological implants have a very high cost and may face rejection.

2. Warnings Warnings

in the use of a prosthesis of the abdominal wall are:

1. that the package is complete, both the external and internal
2. Check the expiry date and dimensional data of the prosthesis
3. Remove the prosthesis directly from the server room to
4. Handle the prosthesis with gloves clean and free talcum powder, to prevent them trapped in the mesh of the prosthesis
5. The prosthesis of the abdominal wall should be used with the best conditions of sterility on non-contaminated. The contamination can cause an infection that prevents the prosthesis from taking root.
6. implants of abdominal wall should not be used in children and pregnant women, where the abdominal area can avere trasformazioni dimensionali.
7. Nel posizionamento di una protesi in videolaparoscopia, è necessario che sia posizionato un trocar di almeno 10 mm. di diametro per consentire alla protesi di entrare in cavità.

3. Preparazione delle protesi

La preparazione di una protesi di parete dipende dalla tecnica impiegata per il suo posizionamento. In chirurgia open la protesi viene generalmente posizionata come si presenta all'apertura della confezione, o può subire delle sagomature relative al luogo nel quale verrà posizionata.
Nella chirurgia videolaparoscopica la protesi non viene solitamente sagomata, ma arrotolata per poter passare attraverso il trocar.
Le protesi sintetiche non necessitano pre-wetting, but instead may be marked for orientation. E 'dermographic can use a pen or a suture.
biological or partially absorbable implants undergo a pre-wetting that restore softness and flexibility. It is used in normal saline to 9% or Ringer lactate solution, or indicated by the manufacturer. Wetting can be performed within the blister where the prosthesis is retained and can last a few seconds.
If the prosthesis should be rolled to pass through a find, this is then grasped with forceps and Johanne introduced.

4. Positioning of the prosthesis implants can

be positioned and then fixed, or can be placed with a fixing point which then allows a subsequent shaping. The important thing is that the prosthesis is well spread over the surface, avoiding the production of folds. If the prosthesis is a double surface is crucial that these be placed conveniently.
to attach the prosthesis can be used wires not absorbable, monofilament mainly because of their elasticity and smoothness. In laparoscopic surgery are used for fixing crimp in various shapes and may be nonabsorbable or absorbable. During their placement is made a counter that allows them to penetrate deep into the thickness of the wall.
If you have used cross-linked implants without a smooth surface, the surgeon first makes a pocket of peritoneal chamber, then placed and fixed the prosthesis and finally closes the peritoneal pocket with wires or crimp.

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