Surgical Cases

Everything You Need to Know About Surgical Cases

Before every surgical intervention, verifying that all pieces of equipment and instruments are functional, sterile, and well organized for immediate use is known as the instrument readiness. It is a paramount standard for the patient's safety. During surgery, lies a patient with an open incision. Blood vessels and organs are exposed, and every action is critical for his or her life. If the surgical team needs a tool or an instrument, that tool should be readily available and handled without delay. 

Hence a well-organized sterile field is a necessary aspect for a practical operation room setup. Essential tools for immediate use should be placed within easy reach and close to the working area, generally in the Mayo stand. Additional supplies and accessories are arranged and stored in trays or on a sterile draped table, often referred to as the backup table.

Surgical instruments are a significant financial expense for hospitals and medical facilities. Proper care, use, and processing of the equipment prolong its life, promote patient safety, and decrease repair and replacement costs. Surgical cases or trays are boxes designated to put the tools in appropriate working order. They are used to protect instruments from damage caused by misuse (entangling or pilling of the devices on top of one another). They are also used to keep them clean and free of debris, sterilized, and properly aligned. In this article, we will cover the history of surgical cases, their indications, market leaders, and some alternatives that may offer the same value.

History of surgical cases 

Surgical Instruments of the modern world come in various shapes, sizes, materials, and technologies. They are always modified and developed for new uses and new specialties.

But all this variety in devices and tools is the result of evolution and development. They are all an extension of what was once in the prehistoric times' crude tools made of stones, animal bones, horns, and antlers. Humans used those tools for survival and daily life activities and, when the medical need arose, the sharpened blades that were used to cut animal flesh were also used to alleviate pain and to relieve human sufferance. One example of a tool that survived unchanged or minimally changed is the cutting blade or knife.

Throughout history, those tools took different shapes. They became made with different materials such as wood, bronze, ivory, and silver until the nineteenth century when the need for asepsis was discovered. Instruments, containers, or trays that hold all those blood-stained instruments had to be sterilized before their use on a patient. However, no material could resist the repetitive damage caused by the sterilization process. In the twentieth century, stainless steel was invented; it is a combination of chromium, carbon, iron, and other metals (alloys). This material made the trays more reliable, more durable, and more resistant to wear and corrosion.

Surgical cases of the modern-day are commonly made with stainless steel. Most of them are of simple structure and are usually used to clean tools. However, some trays serve a specialized application in complicated orthopedic surgeries that require the use of a lot of accessories.

General indications of surgical cases

Surgical cases are an essential part of the setup of the operating room. They allow for a better organization, range of motion, and a more straightforward cleaning process. In this section, we will cover essential procedures that necessitate a distinctive and ideal set up of instruments.

Dilation and curettage

Dilation and curettage is a brief therapeutic procedure; it consists of the dilation of the cervix (the lower part of the uterus), generally using Hegar dilators, a set of metal rods with varying diameters. When inserted into the cervix in increasing order, they create cervical dilation and thus provide an entry to the uterine cavity. Once adequate access to the uterus is gained, curettage begins. It uses a metal rod with a round or oval head, the curette, to scrape the superficial lining of the uterus. The tissue is then removed by suction curette (vacuum).

Dilation and curettage are used for diagnosing or therapeutic purposes. The tissue removed can be used to detect certain precancerous conditions (endometrial hyperplasia) or screen for endometrial cancer.

It is mainly performed in pregnant women to clear the uterine cavity contents after a non-viable pregnancy or incomplete miscarriage. The application of dilation and curettage procedure for invasive abortion is restricted. Because non-invasive medical methods like misoprostol and mifepristone are less expensive and safer, the world health organization recommends using the curette method only when vacuum aspiration is not available.

Exploratory laparotomy

Exploratory laparotomy is an operation that involves the opening of the abdomen through a large incision to explore the organs for possible damage or injury that could not be screened with non-invasive methods. It is the standard procedure in emergency conditions concerning abdominal trauma or internal bleeding that calls for immediate repair.

Once the underlying pathology is identified, and the source of bleeding is controlled, the surgery proceeds to include several other procedures. Depending on the initial findings, it could involve splenectomy (removal of the spleen), hepatic resection, repair of bowel perforation, repairs of major abdominal vessels (aorta and vena cava). Depending on the stability of the patient, the surgery could lead to many other procedures. Thus, the need for a broad set of instruments to be prepared.

Laparoscopic cholecystectomy

In this surgery, doctors remove the gallbladder, a small organ under the liver that secretes a liquid called the bile, which helps to break down the food; the gallbladder is removed either because it is infected (cholecystitis) or damaged by gallstones. Unlike open surgery, which requires a cut in the upper abdomen, laparoscopy is minimally invasive and is accomplished through several minimal incisions. With the help of special instruments, the laparoscopes, a long narrow tube with a high-resolution camera and steady source of light at its end, when inserted in the small incision, it allows for inspection and investigation of the abdominal cavity with the video system assistance.

Other devices similar to the laparoscope are used to expose, grab, and dissect the gallbladder. After clipping and cauterization of any bleeding, the gallbladder is put into a pouch and removed from the abdomen through one of the premade incisions. Laparoscopes and graspers need to be handled very carefully and not jolted away with other tools. They should be grouped and organized in one of the surgical cases.

Carpal tunnel release 

Carpal tunnel release is an invasive operation therapy for the common condition of carpal tunnel syndrome in the wrist, where there is a narrow carpal canal that provides passages to tendons of the muscles that move the fingers. It also provides passage to the median nerve (a nerve that supplies muscles at the palm and the thumb). This nerve becomes compressed by the adjacent tendons, mainly due to repetitive wrist movements. This causes a variety of carpal tunnel symptoms, tingling and numbness over the thumb, index, and middle finger. Rarely, the syndrome is associated with wrist pain. Decompression consists mainly of a cut through the ligament that forms the canal; surgical treatment relieves symptoms for the long term.

Standard specifications of surgical cases

Materials: not all materials are compatible with the sterilization process, some metals oxidize quickly when in contact with certain chemicals or with repetitive use.

Stainless steel: The majority of surgical cases are made with stainless steel because of its resistance and durability. Surgical cases can also be made of anodized aluminum, some types of plastic polymers, and other hybrid materials that combine metal and plastic. Also, stainless steel surgical cases can be perforated, which means they usually have more depth than non-perforated trays used to hold small sterile instruments near the surgical field.

Market leaders

RMS surgical: with over 25 years of metal fabrication experience, this manufacturer provides a variety of single, multilevel, or hybrid designs of surgical cases.

Case medical: a storage solution that is resistant to sterilization and corrosion; their cases are universal and compatible with all devices and sterilizers.

CPT medical: this manufacturer offers custom trays that are designed for immediate use with the advantage of choosing the desired material.

Conclusion: 

Patients' safety in the operating room depends mainly on the perioperative settings and preparations of the surgery. Having a well-organized work field allows for a better range of motion between the mayo stand and the backup table. Surgical cases not only serve the purpose of the arrangement, but they are also the primary sterilization containers of instruments and supply. Their presence in the operating room is necessary.

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