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Discussion

Minilaparotomy and Counts

When performing a minilaparotomy along with robot or laparoscopic assistance (such as when doing a colon resection or colostomy), are instruments to be counted out or not since it is only used to take the specimen out? Instruments would be counted in in this instance in case the surgery converted to open, but I would like to know what other facilities do in regards to instrument count out when closing the minilaparotomy incision. My preference is to count out.

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    We count. The incision to remove the specimen is large enough to lose something. We do have minimal instruments on the field, and group many together (ie, "retractors", not kelly retractors, army navy retractors, etc.)

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         Most hospitals that I have worked at require at least three full counts (initial, closing, and final) if an incision is large enough to admit a surgical instrument.  The incisions made to deliver most body cavity specimens (segment of colon, lung, kidney...) qualify as such

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    If an incision is any bigger than a trocar /port size, then a full count of instruments is done at the prior to start and the end (First and final). All sharps, soft items, sutures etc are counted prior to and at start of closure and before the final sutures /closure of incision/s occur. Your departmental policy should be very clear about this . Remember too that ANYONE can request a count be done at any time. 

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