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Michaela Watkins

Endoscopy Observation Experience

This week at clinical I was observing endoscopic procedures. I got to see two procedures,

a left inguinal hernia repair with mesh and a hysterectomy. For this paper, I am focusing on the

patient who got the hysterectomy. In this reflection I will describe the procedure and its purpose,

patient preparation, the roles of the health care providers, and the nurses’ part in the procedure.

The patient was planned to get a laparoscopic hysterectomy with robot assistance

including removal of the uterus, cervix, left and right ovaries, and the left and right fallopian

tubes. The procedure was pretty long, lasting three hours. The nurse informed me that there was

also signed consent to perform an open surgery if needed. This had to be written in the consent

form or the doctor would not be able to do it. This patient presented to the hospital with pelvic

pain and years of postmenopausal bleeding. She also had uterine prolapse. Once the patient was

prepped and under anesthesia, the procedure began. The first thing that was done was inserting a

foley catheter into the patient. The purpose of this is to keep the urinary bladder empty which

improves the field exposure and eases the steps of the procedure. Next, the uterine manipulator

was inserted, and this allows the operator to flex and rotate the uterus so it can be brought into

the optimal position. After that, 5 small incisions were made in the abdominal. This allowed for

the camera and four “robotic hands” or surgical instruments to be inserted to perform the

procedure.

Once everything was set up and in place, the surgeon went to the Da Vinci surgeon

console, which is a machine that allows the surgeon to sit outside of the sterile field and perform

the procedure. The surgeon controls the instruments and a 3D endoscope with her hands as well

as using foot pedals. The two surgical technicians and RNFA stand around the patient to assist
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with suctioning inside, moving instruments, and controlling the uterine manipulator. The surgeon

cuts through tissue inside and eventually separates the uterus, cervix, ovaries, and tubes from the

vaginal apex. The most interesting part was when the surgical tech removed all the parts by

pulling them out from the vagina. The surgeon then sews up the vagina inside and lastly, a

cystoscopy is performed. This is to check for ureteral patency and no injuries to the bladder.

Once there verified to be no damage, the surgeon with help from the RNFA sutured the 5

abdominal incisions with steri stripes on top. An abdomen pad and abdominal binder were also

placed on the incision site.

There was a lot of preparation involved to prepare the patient and the operating room

(OR) for surgery. For the patient aspect, she was NPO starting the night before surgery. Once the

patient was brought to the OR, she was put onto the operating table and hooked up to machines

to monitor her under anesthesia. A blood pressure cuff, pulse ox, and SCD’s were placed on the

patient. The anesthesiologist intubated the patient and placed an oxygen mask on. The patient

was placed in a lithotomy position with help of the nurse and RNFA. Lastly, the nurse prepped

the patient by cleaning the procedure area with iodine. As for the preparation of the OR, the

surgical technicians set up the sterile field. The nurse assists everyone who will be in the sterile

field with putting their gowns on.

The roles of the surgical team were clearly shown, and communication was key during

the whole process. There were two surgical technicians present. Their jobs were to hand the

surgeon any instruments needed and control the manipulation of the uterine. Also, one of them

removed the uterus, cervix, ovaries, and tubes. The RNFA was in charge of the camera and

inserting tools that were needed, such as the sutures to close inside of the patient. The RNFA

also sutured a few of the abdominal incisions on the patient. The anesthesiologist monitored the
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patients’ vitals throughout the procedure. She also intubated and extubated the patient as well as

administering the anesthesia. The surgeon’s role was obviously to perform the procedure and she

inserted the foley catheter as well. The nurse played a vital role although she did not perform or

assist in the procedure. She went and got any supplies needed by the surgical team. She also

documented the whole procedure. Throughout the procedure the surgical team worked very well

together. Communication was essential. Examples of this were when the surgeon asked the

RNFA to suction when there was too much blood in the procedure area and the surgical

technicians asking the nurse to get extra equipment and supplies to be placed onto the surgical

field. Also, at the end of the procedure when the RNFA was suturing up the sites, he was having

trouble, so the surgeon stepped in and helped.

As I previously mentioned, the nurse’s role was important during the procedure. Before

the procedure began, she took a count of the instruments, and then again at the end. She also

called a time out. During this, she verified the patient’s name, the procedure to be done, and the

site. Everything during the procedure was documented including the instruments and supplied

that were used, the number of incision sites, and the incision dressing. One moment where the

nurse was a patient advocate was at the beginning when positioning the patient. She noticed the

positioning was off, so she asked for help to reposition. After the procedure, she helped to clean

the patient and transfer her to bed in PACU. Most people would believe that the surgeon has the

hardest part during a procedure but asking observing, I believe that the nurse does.

Observing the laparoscopic hysterotomy was a great experience. I enjoyed seeing first-

hand what the different roles of the surgical team entails. I really admired the role of the nurse, as

she did more than what I expected and taught me a lot. It’s a lot different than being a floor

nurse. I can see myself potentially working in the OR in the future. I had a great experience.