Align-ju STUDENT
by 47 %, postoperative complications by 36 % and infections by 48 % [ 10 ].
There are three stages to the use of a surgical safety checklist. In the author ' s practice, the circulating nurse ' s role is to ensure the stage before the start of surgery and the‘ check-out’ at the end of surgery are completed.
Before anaesthesia
Figure 4. Doyen bowel clamps [ 9 ].
A stapler may be used during surgery, rather than suturing the intestinal walls. Compared with suturing, stapling requires less manipulation of the tissue, has good repeatability and provides high strength when healing. A gastrointestinal anastomosis stapler( GIA, Medtronic) is a type of stapler that can be used when performing an enterectomy and anastomosis. This stapler places a double layer of staples into the tissue to provide haemostasis and then resects the tissue between the rows of staples.
Other types of staplers similar to the GIA stapler may be used during GI surgery. One of these is a thoracoabdominal( TA, Medtronic) stapler. Similarly to the GIA stapler, the TA stapler creates multiple rows of staples that provide haemostasis. However, there is no cutting blade in a TA stapler, so the VS must cut the tissue once the staples are in place. Another type of stapler is the Echelon Flex( Johnson & Johnson). Again, it places multiple rows of staples and, like the GIA stapler, has a cutting blade to resect the tissues between the rows.
Suture
Suture material will be needed to close any incisions into the intestine( unless a stapler is used, as described above) and the abdominal incision. An absorbable monofilament suture material can be used to close incisions in the intestine, as it has good knot security, good handling characteristics and minimal tissue reaction [ 1 ].
During the surgery, the circulating nurse passes equipment to the sterile personnel when it is needed and records any consumables, such as suture material, that are used.
Surgical safety checklist
Before the surgery, a surgical safety checklist should be performed. Surgical safety checklists aim to prevent adverse events during surgery [ 10 ]. They were first introduced into human healthcare by the World Health Organization( WHO) in 2008 after seeing how effectively similar checklists worked to improve safety in the aviation industry [ 10 ]. Research has shown that, since the introduction of the WHO surgical safety checklist into human medicine, surgical deaths have reduced
The first part of the surgical safety checklist should be performed before the patient is anaesthetised. It includes confirmation of the following [ 10 ]:
• The patient ' s identity
• The planned surgical procedure
• The anaesthetic machine and airway management equipment have been checked
• Any patient-specific risks for the induction period.
Before the start of surgery
The next part of the checklist should be performed in the theatre before the first incision is made. This section should include the following [ 10 ]:
• Introductions of all staff and any visitors
• Confirmation of the patient ' s name and the planned surgical procedure
• Any patient-specific risks for the surgery, including anaesthetic risks
• Confirmation of any other procedures that are to be performed, such as postoperative radiographs
• A swab count and sharps count, which can be updated during surgery if more are provided
• Confirmation of the sterility of all surgical equipment.
At the end of surgery
The final part of the checklist should be performed towards the end of surgery. It includes [ 10 ]:
• A swab, sharps and instrument count, to ensure nothing is left inside the patient. This is important for all surgeries but especially so for ex-laps, because the patient ' s abdomen is often packed with swabs to prevent GI contamination
• An anaesthetic recovery plan, including the location for recovery
• Any potential risks for recovery
• A record of any adverse events that occurred during the surgery.
Volume 41( 5) • October 2026
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