Operation Cooperation in Laparoscopic Total Gastrectomy

Operation Cooperation in Laparoscopic Total Gastrectomy

Abstract, Objective: To discuss the operation cooperation and nursing experience of laparoscopic total gastrectomy. Methods The clinical data of 11 patients who underwent laparoscopic total gastrectomy were retrospectively analyzed. Results Eleven patients who underwent laparoscopic total gastrectomy were discharged without serious complications.
Conclusion: Laparoscopic total gastrectomy has less trauma, faster exhaust, less pain and faster postoperative recovery for patients. Worthy of clinical application.
Key words laparoscopy; total gastrectomy; operation cooperation; laparoscopic cutting closer
With the deepening of modern surgical minimally invasive concepts, laparoscopic technology has been more and more widely used in clinical practice. Laparoscopic surgery has the advantages of less intraoperative blood loss, less postoperative pain, faster recovery of gastrointestinal function, shorter hospital stay, less abdominal scar, less impact on the immune function of the body, and fewer complications [1]. In recent years, with the continuous improvement of laparoscopic technology, more and more patients with gastric cancer are treated by laparoscopic surgery. Laparoscopic total gastrectomy is difficult to operate and requires a high technical level, and requires close cooperation between the surgeon and the nurse in the operating room to ensure the smooth completion of the operation. Eleven patients who underwent laparoscopic total gastrectomy in our hospital from March 2014 to February 2015 were selected for analysis, and the surgical nursing cooperation is reported as follows.
1 Materials and methods
1.1 General information Eleven patients who underwent laparoscopic total gastrectomy in our hospital from March 2014 to February 2015 were selected, including 7 males and 4 females, aged 41-75 years, with an average age of 55.7 years. Gastric cancer was confirmed by gastroscopy and pathological biopsy before operation in all patients, and the preoperative clinical stage was stage I; there was a history of upper abdominal surgery or major abdominal surgery in the past.
1.2 Surgical method All patients underwent laparoscopic radical total gastrectomy. All patients were treated with general anesthesia and tracheal intubation. Under pneumoperitoneum, the omentum and omentum were dissected with ultrasonic scalpel and Ligasure to dissect out the perigastric blood vessels, and the lymph nodes around the left gastric artery, hepatic artery, and splenic artery were cleaned. The stomach and duodenum, stomach and cardia were separated by laparoscopic cutting and closing device, so that the whole stomach was completely free. The jejunum was lifted close to the esophagus, and a small opening was made in each of the esophagus and jejunum, and the esophagus-jejunum side anastomosis was performed with a laparoscopic cutting and closing device, and the opening of the esophagus and jejunum was closed with the laparoscopic cutting and closing device. Similarly, the free end of the jejunum was anastomosed to the jejunum 40cm away from the suspensory ligament of the duodenum. A 5cm incision was made between the lower mouth of the xiphoid process and the umbilical cord to remove the gastric body. Gastric body and lymph node specimens were resected and sent for pathological examination. The peritoneal cavity was flushed with fluorouracil saline, and a drainage tube was placed to close the abdominal cavity [2]. The trocar was removed and each poke was sutured.
1.3 Preoperative visit Visit the patient in the ward 1 day before the operation to understand the general condition of the patient, review the case, and check the results of various laboratory tests. Participate in the preoperative discussion in the department if necessary, and make full preparations for the operation on the second day. Laparoscopic gastric cancer resection is still a relatively new treatment method, and most patients do not know enough about it and have doubts about it to some extent. Due to the lack of understanding, they will worry about the curative effect and safety of the operation, and then there will be psychological problems such as nervousness, anxiety, fear and even not wanting to have the operation. Before the operation, in order to eliminate the patient’s nervousness and better cooperate with the treatment, it is necessary to explain the safety and effectiveness of the operation to the patient, and use the successful operation as an example to enhance the patient’s sense of security and treatment confidence. Let patients maintain a relaxed state of mind and build confidence in fighting the disease.
1.4 Preparation of instruments and items: 1 day before the operation, check with the surgeon whether there are any special surgical instrument requirements, whether there is any change in the routine operation steps, and make corresponding preparations in advance. Routinely prepare laparoscopic surgical instruments and check the disinfection status, and check whether the ultrasonic scalpel, monitor, light source, pneumoperitoneum source and other equipment are complete and easy to use. Prepare and perfect various types of laparoscopic cutting closers and tubular staplers. Like all other laparoscopic operations, laparoscopic total gastrectomy also faces the problem of conversion to laparotomy, so laparotomy instruments need to be prepared routinely. In order not to affect the progress of the operation due to insufficient preparation during the operation, or even endanger the life of the patient.
1.5 Cooperate with the patient during the operation and establish venous access after checking the identity information is correct. After assisting the anesthetist to perform anesthesia, place the patient in an appropriate position and fix it, place a urinary catheter, and properly fix the gastrointestinal decompression tube. The device nurses wash their hands 20 minutes in advance, and count the devices, dressings, needles and other items together with the roving nurses. Assist the surgeon to disinfect the patient, and use a sterile protective sleeve to isolate the lens line, light source line, and ultrasonic knife line [3]. Check whether the pneumoperitoneum needle and aspirator head are unobstructed, adjust the ultrasonic knife; assist the doctor to establish the pneumoperitoneum, pass the trocar laparoscopic exploration to confirm the tumor, deliver the instruments and items needed for the operation in time, and assist the doctor to deflate the abdominal cavity during the operation Inner smoke ensures a clear surgical field. During the operation, aseptic and tumor-free techniques should be strictly implemented. The installation of the staple cartridge is actually reliable when passing the laparoscopic cutting closer, and it can be passed to the operator only after the model is confirmed. Close the abdomen and check the surgical instruments, gauze, and suture needles again.
2 results
None of the 11 patients underwent conversion to laparotomy, and all operations were completed under complete laparoscopy. All patients were sent for pathological examination, and the results showed that the postoperative TNM staging of malignant tumors was stage I. The operation time was 3.0~4.5h, the average time was 3.8h; the blood loss during operation was 100~220ml, the average blood loss was 160ml, and there was no blood transfusion. All patients recovered well and were discharged from the hospital 3 to 5 days after the operation. All patients had no complications such as anastomotic leakage, abdominal infection, incision infection, and abdominal bleeding, and the surgical effect was satisfactory.
3 Discussion
Gastric cancer is one of the most common malignant tumors in my country. Its incidence may be related to factors such as diet, environment, spirit or genetics. It can occur in any part of the stomach, seriously threatening the physical and mental health and life safety of patients. Currently, the most effective clinical treatment The method is still surgical resection, but the traditional surgical trauma is large, and some elderly patients or those in poor physical condition lose the opportunity for surgical treatment due to intolerance [4]. In recent years, with the continuous development, improvement and application of laparoscopic technology in clinical work, the indications for surgery have been further expanded. Domestic and foreign studies have proved that abdominal surgery has more advantages than traditional surgery in the treatment of advanced gastric cancer. But it also puts forward higher requirements for the cooperation between the surgeon and the nurse in the operating room. At the same time, nurses in the operating room should do a good job in preoperative visits and communicate with patients to understand the patient’s psychological state and physical condition. Improve the preparations for surgical items and operating room before the operation, so that the items are placed in an orderly manner, convenient and timely; during the operation, closely observe the patient’s urine output, bleeding volume, vital signs and other indicators; Predict the operation process in advance, deliver surgical instruments timely and accurately, master the principles, use and simple maintenance of various endoscopic instruments, and ensure the smooth progress of the operation to the greatest extent. Strict aseptic operation, conscientious and active operation cooperation are the keys to ensure the smooth implementation of the operation.
To sum up, laparoscopic total gastrectomy has less trauma, faster exhaust, less pain and quicker postoperative recovery for patients. Worthy of clinical application.

references
[1] Wang Tao, Song Feng, Yin Caixia. Nursing cooperation in laparoscopic gastrectomy. Chinese Journal of Nursing, 2004, 10 (39): 760-761.
[2] Li Jin, Zhang Xuefeng, Wang Xize, et al. Application of LigaSure in laparoscopic gastrointestinal surgery. Chinese Journal of Minimally Invasive Surgery, 2004, 4(6): 493-494.
[3] Xu Min, Deng Zhihong. Surgical cooperation in laparoscopic assisted distal gastrectomy. Journal of Nurses Training, 2010, 25 (20): 1920.
[4] Du Jianjun, Wang Fei, Zhao Qingchuan, et al. A report on 150 cases of complete laparoscopic D2 radical gastrectomy for gastric cancer. Chinese Journal of Endoscopic Surgery (Electronic Edition), 2012, 5(4): 36-39.

Source: Baidu Library