In our Top 10 series, we've covered several specialties, including Orthopedics, Cardiac, and Vascular. Today, we're going to be talking about Gynecology (GYN) Surgery. What do you need to know? What are the basics that will ensure you're set up for success if you find yourself in a GYN case? Check out our Top 10 to find out!
Top 10 Things To Know About Gynecology Surgery:
#1 Always be prepared to convert from laparoscopic or vaginal to open
It’s better to have something and not need it than to need it than not have it. That was a lesson I was taught once in a GYN rotation as a new nurse. How many times have you had to convert and had to go running for everything? Being prepared for what could happen will help make a crazy situation more calm and allow for a safer outcome for the patient. If you're doing a laparoscopic case, simply having the equipment and instruments available should you need to open will save you a lot of stress - and a lot of steps!
#2 Positioning is key to avoid nerve injuries
Lithotomy position is known for being a position that can lead to nerve damage if not done properly. It’s not a position the body is naturally used to being in for hours at a time. It’s imperative that you ensure the leg is in the stirrup holder properly and anatomically. Otherwise, if it is left in an improper position for any length of time, the patient can experience nerve damage in the leg, back and buttocks.
#3 Know the proper stirrup location and secure properly
Patients come in all shapes and sizes, as we know, so where the stirrup was placed for one case, may not be the same the place needed for a following case. Location is patient dependent. Also make sure the stirrup is properly secured to the bed. A faulty clamp could cause the stirrup to fall off the bed in the middle of a procedure (I’ve seen it before) and this could lead to severe patient harm. Ensure these devices are in proper working order before the patient comes into the room.
#4 Ensure and maintain privacy
Our patients are already in a vulnerable state coming into surgery. But in GYN surgery, they are even more exposed and vulnerable. They know they will be in compromising positions with sensitive areas being seen by many, and this can cause a patient to experience great anxiety. Making sure the shades on the windows are closed, monitoring who's coming in and out of the room, and exposing only the areas necessary are ways to ensure the patient is protected when they cannot advocate for themselves. Also, be up front with your patient as to who will be in the room. Ask them if they are ok with students or other medical observers in the room. If they are not we must abide by what the patient wants and make sure no one is in the room who shouldn’t be there. These things will ensure our patient is protected.
#5 Know your labs
This can help you prepare in case things begin to deteriorate. Knowing a patient’s hemoglobin and hematocrit, for example, can be crucial information if there is unexpected bleeding or the procedure is longer than expected. Making sure the patient has been typed and crossed is an important lab to have done in case the need to give blood is warranted. Depending on the procedure being performed, there may be surgery-specific labs to be conducted. Knowing all of this information before rolling back will help make sure that things run as smoothly as possible during the procedure.
#6 Confirm pregnancy status
This lab value needs its own bullet point. There have been many times a patient has come in for surgery and she didn't know she was pregnant - until the lab work said so. This information will determine if the surgery can continue or if we have to cancel the procedure so further workup can be performed. Not knowing a patients’ pregnancy status could put both the mother and unborn child at risk.
#7 Know your GYN subspecialties
GYN oncology, infertility, urogynecology, and Maternal/Fetal medicine to name a few. All of these subspecialties have specific procedures that they perform. It’s good to be aware of specialties as they may operate differently from general GYN procedures.
#8 Be mindful of cross-contamination when prepping
Many preps for GYN cases involved prepping the abdomen and perineal area. Preventing cross-contamination is a MUST. Two separate prep set ups and gloves are necessary.
The vaginal prep should be performed first, then, with new gloves and prep stick, perform the abdominal prep. (Phillips, N. F., Hornacky, A., Berry, E. C., & Kohn, M. L. (2021). Positioning, Prepping, and Draping the Patient. In Berry & Kohn’s operating room technique (pp. 513), Elsevier.)
#9 Implement laser safety during specific surgical procedures
Lasers are commonly used as treatments during GYN surgeries. Endometriosis, cancers, and dysplasias are just a few examples. When a laser will be used, consult laser policies at your facility. This checklist usually includes making sure sterile fluid is on the field in case of a fire, eye protection for everyone in the room including the patient, smoke evacuation apparatus is in use, laser filter masks for staff, and placing signs on the doors warning others that a laser is in use. It is crucial to follow safety guidelines when lasers are in use so the patient and OR staff do not encounter a disaster.
#10 Verify specimens
GYN surgeries can have a lot of specimens, especially in oncology. The surgical tech or scrub nurse must make sure that all specimens are passed off in the proper order. The circulator must make sure that all specimens are properly labeled and in the proper solution before going to the pathology department. Always read back the specimen once the surgeon has removed a part of the body. Wrong specimens can have detrimental affects like delayed or wrong diagnosis or subsequent surgeries. Never be afraid to verify what has been said and always read it back to the field.
This brings us to the end of our top 10, but there's always more to learn! What would you add to this list that someone working in GYN surgery MUST know? We'd love to hear what you would add and what advice you can share!
Lindsey
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