Operating Room Setup & Nursing Guide
A practical guide written from the perspective of an Operating Room Nurse.
The workflows, surgeon preferences, and nursing tips presented in this article are based on the author’s real clinical experience. Surgical techniques and operating room practices may vary depending on the surgeon, hospital, and institutional protocols.
Quick Facts
| Item | Information |
|---|---|
| Procedure | Laparoscopic Appendectomy |
| Position | Supine → Trendelenburg + Right Tilt |
| Ports | Usually 3 Ports |
| Camera | 10 mm 30° or 5 mm 30° |
| Energy Device | Voyant / LigaSure / Thunderbeat |
| Stump Closure | Endoloop or Weck Clip |
| Skin Closure | Nylon 3-0 |
| Dressing | Neo Dressing or Fixroll |
Procedure Timeline
- Patient Position
- Trocar Insertion
- Exploration
- Mesoappendix Division
- Appendix Stump Closure
- Specimen Retrieval
- Final Inspection
- Fascial Closure
- Skin Closure
- Dressing
Patient Position
The patient is initially placed in the supine position.
After all trocars have been inserted, the operating table is changed to the Trendelenburg (head-down) position with the patient tilted toward the right-up side to improve visualization of the appendix.
Trocar Placement
Common Setup
| Location | Size |
|---|---|
| Umbilicus | 10 mm |
| Left Lower Quadrant | 5 mm |
| Suprapubic | 5 mm |
Surgeon Preference
Trocar placement differs depending on surgeon preference.
Common examples include:
- 10 mm + 5 mm + 5 mm
- 12 mm + 5 mm + 5 mm
Some surgeons also change the location of the working ports.
Camera System
Commonly used laparoscopes include:
- 10 mm 30°
- 5 mm 30°
The preferred scope should always be confirmed before surgery.
Energy Device
The energy device varies by surgeon or hospital.
Common examples include:
- Voyant™
- LigaSure™
- Thunderbeat™
Appendix Stump Closure
Several closure methods are commonly used.
Option A
- Endoloop (1-0)
Option B
- Three Weck Clips
The preferred technique depends on the surgeon.
Specimen Retrieval
After division of the appendix, the specimen is placed into a laparoscopic retrieval bag.
The bag is usually removed through the umbilical port.
Following specimen retrieval, the trocar is reinserted to:
- Re-establish pneumoperitoneum
- Inspect the operative field
- Check for bleeding
- Irrigate if necessary
- Remove remaining fluid
Fascial Closure
The umbilical fascial defect is closed after the final inspection.
Method A
- Kocher ×2
- Vicryl J 1-0
Method B
- Kelly ×2
- Vicryl J 1-0
The closure method depends on surgeon preference.
Skin Closure
A commonly used technique includes:
- Nylon 3-0 interrupted sutures
Skin closure techniques may vary depending on surgeon preference.
Dressing
Method A
- Sterile Gauze
- Neo Dressing
Method B
- Sterile Gauze
- Fixroll
Mayo Stand Setup
Before Trocar Insertion
- Mess
- Adson Forceps
- Senn Retractor
- Mosquito ×2
- Kelly ×2
- Bovie
- Trocars
After Camera Insertion
- Laparoscopic Dissector
- Laparoscopic Grasper
- Energy Device
- Endoloop
- Laparoscopic Scissors
- Retrieval Bag
Back Table Setup
Personal Preference
I prefer keeping the following items on the back table until they are needed:
- Endoloop
- Laparoscopic Scissors
- Retrieval Bag
This helps keep the mayo stand organized and prevents unnecessary overcrowding.
30-Second OR Checklist
Before incision, confirm:
- Camera white balance completed
- Camera focused
- CO₂ insufflator connected
- Energy device tested
- Suction available
- Endoloop prepared
- Retrieval bag available
- Correct trocar sizes prepared
- Patient positioned correctly
- Antibiotics administered
Common Pitfalls
Preparing the retrieval bag too late
Prepare the retrieval bag before appendix division whenever possible.
Overcrowding the mayo stand
Keep only frequently used instruments on the mayo stand.
Forgetting surgeon preference
Always confirm the following before surgery:
- Camera size
- Trocar size
- Energy device
- Closure method
Pearls from Experience
These tips reflect my personal workflow and may differ depending on the hospital or surgeon.
- I prepare the retrieval bag before the appendix is completely divided.
- I keep the Endoloop and retrieval bag on the back table until they are needed.
- Before fascial closure, I prepare the Vicryl J 1-0 suture together with the surgeon’s preferred grasping instrument.
- Every surgeon has different preferences. Learning those preferences is just as important as learning the procedure itself.
Frequently Asked Questions
How many ports are commonly used?
Three ports are most commonly used, although the size and location may vary depending on surgeon preference.
Which energy device is commonly used?
Voyant™, LigaSure™, and Thunderbeat™ are all commonly used depending on surgeon preference and available hospital equipment.
Is Endoloop always used?
No.
Some surgeons prefer Endoloop, while others use Weck clips.
Why is the trocar reinserted after specimen retrieval?
It allows the surgeon to inspect the operative field, confirm hemostasis, perform irrigation if necessary, and ensure the abdomen is ready for closure.
Conclusion
Laparoscopic appendectomy is a routine operation, but operating room preparation often varies according to surgeon preference and institutional workflow.
Understanding these variations, anticipating the next step, and maintaining an organized sterile field can help the scrub nurse support a smoother and safer operation.