Endoscopic Abdominoplasty + Liposuction (NO FAT GRAFTING)

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  •  Dr. Brown:
    • Gown – XL, XL Length
    • Gloves – 8 Indicator Glove, 7.5 Biogel Glove
  • Dr. Chandler:
    • Gown – L
    • Gloves – 5.5, 6.0 if 5.5 unavailable
  • Sean Kirby PA-C:
    • Gown – XL
    • Gloves – 7.5 Indicator Glove, 7 Nonlatex Glove
  • Pre-operative Medications
    • Night before (prescribed pre-op):
      • Scopolamine patch placed behind ear
      • Shower with Hibiclens for couple days before surgery 4% topical chlorhexidine soap.
    • Upon check in for surgery (prescribed pre-op):
      • Tylenol 975mg PO x1
      • Gabapentin 600mg PO x1
      • Celebrex 400mg PO x1
  • Intra-operative Medications
    • Ancef 2 grams IV (ok if allergic to Penicillins).
    • Vancomycin 1g IV (if allergic to Ancef)
    • Infiltration Solution (Dr. Brown will inject into abdominal wall near end of case):
      • NS or LR 500 mL
      • Ropivicaine 300mg
      • Clonidine 0.3mg
      • Dexamethasone 4mg
    • Liposuction tumescent.   1L LR or NS mixed with 2 amps 1:1000 epi.   Usually need 3-5 liters total.
  • Post-operative Medications (Prescribed pre-op)
    • Tylenol 650mg PO q6 hours scheduled
    • Methocarbamol 1500mg PO q6 hours scheduled
    • Gabapentin 300mg PO q6 hours scheduled
    • Cephalexin 500mg PO q6 hours scheduled for 4 doses starting after surgery
    • Pericolace 1 tab PO BID scheduled
    • Phenergan 25mg PO q8 hours PRN nausea
    • Oxycodone 5mg tabs, 1-3 tabs PO q4 hours PRN pain
    • Ibuprofen 600mg PO q6 hours scheduled, starting 48 hours after surgery
  • Anesthesia
    • GETA.  Will need paralysis during abdominal wall plication.
    • Easy on the IV fluids as I will be infusing a tumescent solution.
  • Patient Position
    • Supine.  Will roll side to side during prep and case.  Will need to reflex hips during closure.
  • Bed Attachments
    • Arm boards
    • Ulnar nerve pads, No kerlex – only straps because we will be rolling into lateral two times.
  • Patient Warming
    • Lower BodyBair Hugger AND upper body bair hugger AFTER liposuction which is the first part of the case.  No underbody bair-bugger as it is too cumbersome.
    • Place Liposuction tumescent into blanket warmer.  Place Chloroprep sticks into blanket warmer.
    • IV fluid warmer for anesthesia
  • DVT Prophylaxis
    • Bilateral SCDs in OR. ON and working BEFORE induction of anesthesia.
  • Foley Catheter
    • YES.  Run tube thru part of an SCD so it won’t pull on bladder when we roll side to side.
  • Instrument Sets
    • Breast & Body or Minor plastic set.
    • Need long narrow retractors x2 for abdominal plication.
    • Endoscopic set with zero degree scope and light source.
    • Endoscopic tower
    • Power Liposuction Set
  • Surgical Packs
    • 3/4 sheet x2
    • Universal pack
  • Surgical Prep
    • Chloraprep circumferential.   Will need 8, pre-warmed in towel warmer.
  • Irrigation Solutions
    • Room Temp Normal Saline
  • Blades
    • 11 x 2
    • 10 x 2
  • Bovie
    • Short Protected ENT tip x 1
    • Longest protected ENT tip or regular.  Length is most important, then I’d prefer protected but length is priority.
      • 60/60 pure and fulgarate
  • Suture
    • #1 Prolene – largest taper needle for abdominal plication x 2
    • 2-0 PDS Large taper x 6
    • 3-0 Monocryl Large cutting x  4
    • 3-0 v-Loc (absorbable) Long, Large Cutting x 2
    • 4-0 Plain Gut Large cutting x 1
    • 2-0 Nylon Large cutting x 2 for drain
  • Drains
    • 10 mm flat perforated drain, 100mL bulb reservoir
  • Additional Supplies
    • Marking pen, Paper Ruler x 4
  • Dressing
    • Mastisol
    • Wide Long Steri strips
    • Xeroform for umbilicus
    • Kerlex to fluff under binder

 

Order of procedure:

  1. circumferential prep:  side, tuck, other side, anterior then universal drapes
  2. Infusion tubing will start on sterile field, pass spike off field to insert into tumescent bag.     This tubing will then be passed thru the pump.   The remaining sterile end will go onto the 5mm basket or double basket liposuction cannula which may require an adapter depending on the type of infusion tubing used.    Dr. Brown will infuse fluid while you all set up lipo equipment
  3. Set up lipo equipment.  Suction tube and power cord.
  4. Anterior liposuction
  5. Right lateral liposuction:   infuse tumescent, suck it out.
  6. Left lateral liposuction:   infuse tumescent, suck it out.
  7. Close access holes with 3-0 monocryl.
  8. Supine for Abdominoplasty. Re-prep with betadine paint.
  9. Incision with 10 blade.  11 blade for umbilicus.  Will not need the bovie or 10 blade until this step.
  10. Use endoscopic camera and light source to dissect way up to xiphoid thru short abdominal incision.  Will need 2 narrow and long retractors for this.  One in umbilicus hole and the other in the lower abdominal incision.  Extended tip bovie.
  11. Plicate abdominal wall:  marking pen, #1 or larger PDS Stratafix,  0 or larger Ethibond.
  12. Irrigate with NS, place one 15 round drain with trocar.  Suture in with 2-0 nylon.
  13. Close skin (0-vicryl, 3-0 monocryl, 3-0 barbed suture, 4-0 plain)
  14. Dressings (mastisol and long wide steris, fluffed kerlex, loose binder)
  15. Transfer to stretch KEEPING the patient in the reflex position.
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