Perioperative issues at ERC

A patient may wait for one year or more before getting approval from the government for surgery.  If there is no approval the patient can pay cash and have surgery at any time in a private hospital. 

Patients are admitted to the Endocrine Research Center 1-5 days before a planned operation. During this time the workup is finalized or repeated.  There is no patient transportation around the center, so most patients take the elevator or walk up and down the stairs to move around the hospital for testing.  We walked with a patient down 4 flights of stairs to bring her to the Ultrasound department.

Patients are taken to and from the operating room on a gurney just like in the US.

Cloth drapes and gowns are used for most operations. The surgeon washes with alcohol/chlorhexidine and dries with a sterile towel. An alcohol/chlorhexidine solution is then applied to the hands and arms and allowed to air dry. The scrub nurse hands the surgeon a gauze soaked in alcohol which is used to clean the hands a third time. The scrub nurse gowns the surgeon and ties the sleeves of the gown around the surgeon's wrists. They do not seme to care at this point if the I gloved hands come in contact with the surgeon's bare hands. After the surgeon is gloved, the gloves are cleaned with alcohol.  The patient is prepped with betadine and alcohol.

The patient's legs are wrapped with a compressive gauze to prevent deep venous thrombosis.

This is an example of a sterile pack for a thyroidectomy. 

Laparoscopic instruments are all reusable - never disposable.  Trocars are all metal - not plastic. 

Energy devices are reprocessed, re-sterilized and reused up to 20 times. Cloth drapes are used for most operations.  Paper drapes are used for patients with hepatitis or HIV, and energy devices are disposed of after operating on patients with hepatitis or HIV.  

This is an example of a device that is used for the retrieval of adrenal tumors.  It appears to be a large latex sheath.



Large single lumen drains are routinely used after laparoscopic adrenalectomy and chyle leak is commonly seen. Drains are routinely used after thyroidectomy, neck dissection and parathyroidectomy.

After a thyroidectomy the drains will be removed on the first or second postoperative day and the patient will be discharged on the third postoperative day.  The patients are all placed on levothyroxine the day after total thyroidectomy because they may not get radioiodine for up to 3 months.