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JUNE 2016 | The Surgical Technologist | 263 scope can be white balanced. Once white balancing has been tested, the 4”x4” will be moistened so the straight bi-polar electrode can be tested. At this point, the surgeon will place the scope into the tubular retractor. The first instrument used will be the pituitary rongeur. This is used to remove soft tissue and muscle overlying the lamina. Next, the ligamentum flavum — which is an elastic tissue that runs from the axis to the sacrum — is identified. The ligamentum flavum connects the lamina and fuses with the facet joint. Ligamentum flavum translates into “yellow ligament” because it looks yellow due to the collagen found in the flavum. As people age, the ligament loses elastin, causing the flavum to thicken and push into the spinal canal. The surgical technologist will clean the flavum and lamina off of the spoon each time the surgeon removes it from the tubular retractor. Once the ligamentum flavum has been removed and the bone is reached, a drill will be used to carefully remove por- tions of the lamina. A 4mm 40° and 90° Kerrison rongeur, and chisel with mallet will be used to remove the lamina. When the surgeon thinks he has removed enough flavum and lamina, a blunt dilator will be used in conjunction with fluoroscopy to see how much progress has been made. If all looks well, the surgeon will ensure the nerve rootlets are intact and that the spinal cord has pulsations. If not, more drilling and removal of the lamina will be performed. Once that step is complete, the endoscope will be removed along with the tubular retractor with fluid adaptor. The surgical technologist will make a small tear in the iodine-impregnat- ed incision drape around the incision and dry the area with clean 4”x4” gauze. At this time, the surgical technologist will pass 3-0 nylon suture. Since the incision is small, usually only two sutures will need to be placed. P O S T - O P Following the operation, the patient will be transferred to recovery via a stretcher after extubation. The patient will be monitored until they are aware of their surroundings. Their feet and legs will be checked for movement, and then the patient will be moved to the edge of the bed with assistance. The patient will be required to take several steps to reach a wheelchair, and then taken via a wheelchair to a restroom to void. After this is achieved, and the patient is oriented enough to leave, they will be discharged. The process from extubation to discharge usually lasts between two and three hours. One week after the procedure, the patient will return to EQUIPMENT: • Radiolucent spinal frame • Headrest • C-arm fluoroscopy and monitor • Bipolar electro-cautery machine • 0.9% sodium chloride • Suction • Drill machine • Monitor for endoscope SUPPLIES: • Iodine-impregnated incision drape • Irrigation tubing • Suction tubing • Chest/breast drape • Mayo cover • Yankauer suction catheter • 2 - 5cc syringes with 25x1” needle filled with 0.25% bupivacaine hydrochloride with epinephrine • 3-0 nylon suture • #11 Blade • Raytech sponges • C-arm cover • Medicine basin • Scrub basin with sterile water • 22-gauge x 3.5” needle INSTRUMENTS: • Pituitary rongeur • 2-mm, 3-mm and 4-mm Kerrison rongeurs • 45-degree up-biting grasper • Basket punch • Curette • Chisel • Blunt dissector • 7-mm dilator • Endoscope • Tubular retractor with fluid adaptor • Drill, shaft, handpiece and drill cord • Camera • Light cord • Straight and curved bi-polar with handle and cord • Hammer • Adson with teeth • Needle driver • Straight Mayo scissors • Iris scissors • Nerve hook • Trephine