The surgical assistant, a manual for students, practitioners, hospital internes and nurses . Fig. 67. Trap-door incision. Disposition of assistants hands for incisionof posterior rectus sheath between two forceps. as originally made or as subsequently enlarged, exposes thedeep epigastric vessels beneath the rectus muscle, they shouldbe drawn aside gently by the assistant or, if they cannot bethus spared, they are to be clamped on each side and ligatedin continuity. 188 The Surgical Assistant. opening the peritoneal cavity. The parietal peritoneum, exposed by one of the abovemethods, is seized

- Image ID: 2AJ87KH
The surgical assistant, a manual for students, practitioners, hospital internes and nurses . Fig. 67. Trap-door incision. Disposition of assistants hands for incisionof posterior rectus sheath between two forceps. as originally made or as subsequently enlarged, exposes thedeep epigastric vessels beneath the rectus muscle, they shouldbe drawn aside gently by the assistant or, if they cannot bethus spared, they are to be clamped on each side and ligatedin continuity. 188 The Surgical Assistant. opening the peritoneal cavity. The parietal peritoneum, exposed by one of the abovemethods, is seized
The Reading Room / Alamy Stock Photo
Image ID: 2AJ87KH
The surgical assistant, a manual for students, practitioners, hospital internes and nurses . Fig. 67. Trap-door incision. Disposition of assistants hands for incisionof posterior rectus sheath between two forceps. as originally made or as subsequently enlarged, exposes thedeep epigastric vessels beneath the rectus muscle, they shouldbe drawn aside gently by the assistant or, if they cannot bethus spared, they are to be clamped on each side and ligatedin continuity. 188 The Surgical Assistant. opening the peritoneal cavity. The parietal peritoneum, exposed by one of the abovemethods, is seized with tissue forceps by the assistant oppo-site the point grasped by the operator and lifted away fromthe underlying viscera. If there be much intra-abdominaltension, the belly wall itself should be lifted up with the re-tractors. After a small nick in the peritoneum has been madebetween the two forceps, with a scalpel, the assistant shouldcontinue his grasp until the surgeon has transferred his for- SUR0E0N5 LEFT HAND. SURGEONS RIGHT HAND ASSISTANTS UFT HAND Fig. 68. Enlarging the peritoneal opening. Assistant prevents injury tounderlying viscera by depressing them with blunt scissors and lifting the bellywall with retractors. ceps to the edge of the opening. This the assistant may thenalso seize on the opposite side, if necessary. A pair ofstraight, blunt-pointed scissors with which to enlarge theopening is now handed to the operator. It may be necessaryfor the assistant to insert just under the peritoneum a pairof blunt scissors or a similar instrument to protect the viscera Abdominal Operations. 189 from injury while the peritoneum is being thus further in-cised (figure 68). At this stage of the operation the anes-thetist must make sure that the patient is well under,lest intestine or omentum be strained through the wound.In any case a narrow packing should be ready for introduc-tion to restrain protruding gut. If the abdominal wall be thick, or the wound be small, theassist

Similar stock images