1. Surgeon Name: HYPOSPADIAS OR Protocols Template for: HYPOSPADIAS There are explanations of each template - how it will look when finished and how to correctly complete each template. Please fill each section out and return to max.maizels@gmail.com 1.OR Checklists 2.Procedure Sequence Guide 3. Room Arrangement 4. Instrument Labels Richard Grady, MD

2. Surgeon Name: Glove Size: OR Protocols - General Checklist Please use the line shape below to cross out items on the example checklist that you do not wish to have included on your personal checklist. If you wish to add additional items not listed here, please use the following slides to add them to the appropriate section. Copy, paste and move this line as many times as required. Richard Grady, MD 7.5 Sensicare

3. DoneN/A 1. Pre-Flight (Preparations) Checklist Please add any items you wish to include on your list. General: For All Cases Anesthetic plan established Preoperative antibiotics established Regional Block Type established Resident/Fellow participating established Bipolar pedal location and settings established

4. DoneN/A Please add any items you wish to include on your list. 2. In-Flight (Procedure) Checklist General: For All Cases

5. DoneN/A Please add any items you wish to include on your list. DoneN/A DoneN/A NEXT Case Preparations: THIS Case Preparations: 3. Landing (Post-Procedure) Checklist General: For All Cases Determine location of next patient Need for H/P or consent of next patient Parents notified PACU orders written Postoperative antibiotics and pain medication plan established Postoperative orders written Disposition established Equipment issues Improvements

6. Surgeon Name: Procedure: Glove Size: OR Protocols – Procedure Checklist Please use the line shape below to cross out items on the example checklist that you do not wish to have included on your personal checklist. If you wish to add additional items not listed here, please use the following slides to add them to the appropriate section. Copy, paste and move this line as many times as required. Hypospadias Richard Grady, MD 7.5 Sensicare

7. DoneN/A 1. Pre-Flight (Preparations) Checklist Please add any items you wish to include on your list. Hypospadias-Specific 8 french feeding tube and lube Small tegaderm x 2, telfa and steri strip, coban Sutures: 5-0 Prolene, 7-0 PDS, 6-0 PDS, 5-0 Monocryl Bipolar cautery set to 20, pedal to right of patient Needle tip on bovie electrocautery Cut Prolene suture in half and load on needle holder Cut 7-0 PDS in half and load each half on a Castro needle holder

8. DoneN/A Please add any items you wish to include on your list. 2. In-Flight (Procedure) Checklist Hypospadias-Specific

9. DoneN/A Please add any items you wish to include on your list. DoneN/A DoneN/A NEXT Case Preparations: THIS Case Preparations: 3. Landing (Post-Procedure) Checklist Hypospadias-Specific Postoperative pain management established Postoperative prophylactic antibiotics established Post operative appointment for stent removal made

10. OR Protocols – Procedure Sequence Guide Here is an example of the procedure sequence guide. It contains components and steps for each part of the surgery. The 3 rd column lets the nurse or scrub tech know what instrument to have ready. Please use the following slides to create your procedure sequence guide with the specifics of how you perform the surgery.

11. Components StepsInstruments / Scrub Tech Surgical Procedure: HYPOSPADIAS Prepare Penis 1.Retract foreskin and clean glans 2.Place traction stitch into glans 3.Mark incisions 4.Insert feeding tube, drain penis 1.2 raytecs and betadine 2.5-0 Prolene, gnat, suture scissors, stage, mosquito 3.Marking pen, 0.5 pickup 4.8 fr feeding tube with lube, green towel Deglove Penis 1.Incise skin 2.Deglove penis 3.Establish hemostasis 4.Consider tourniquet 1.15 blade scalpel, beaver blade 2.0.5 pickup, tenotomy scissors, sharpie scissors, small Wescott scissors 3.Bipolar cautery 4.Vessel loop 5.Mosquito Repair of Penile Angulation 1.Perform erection test if needed 2.Mark point of maximal curvature 3.Incise Buck’s fascia 4.Plicate penis 5.Close Buck’s fascia 1.Vessel loop, mosquito, 27g Butterfly needle and injectable saline 2.Marking pen 3.0.3 pickup x 2 and Wescott scissors 4.5-0 Ethibond suture 5.6-0 PDS suture Glans Incision 1.Mark glans 2.Make glans incision 3.Establish hemostasis 4.Incise plate if desired 1.Marking pen 2.0.5 pickup x 2, 15 blade scalpel, sharpie scissors 3.Bipolar cautery Urethroplasty 1.First layer of urethroplasty 2.Harvest dartos flap 3.Anchor flap over anastomosis 1.0.12 pickup x 2 2.7-0 PDS on Castro Viejo driver 3.Sharpie scissors 4.6-0 PDS Glansplasty 1.Close glans in 2 layers 2.Re-approximate mucosal collar 1.6-0 PDS 2.Tenotomy scissors Skin Coverage 1.Release tourniquet if used 2.Establish hemostasis 3.Raise skin flaps 4.Tailor and re-approximate skin 1.Bipolar electrocautery 2.Marking pen 3.Tenotomy scissors 4.5-0 Monocryl Dressing 1.Stitch traction suture to feeding tube 2.Wash penis 3.Apply adhesive and dressing 1.French eye needle 2.Wets and drys 3.Telfa and steri strip, tegaderm x 2, scissors, coban

12. Components StepsInstruments / Scrub Tech

13. Components StepsInstruments / Scrub Tech

14. OR Protocols – Room Arrangement This section shows how the room should be arranged for each procedure and where each staff member generally stands. On the following slide, move the objects around to position them correctly for your hypospadias procedure. If you need more objects, simply copy and paste one, then double click the text to change the name of the item. IV Pole Foot Pedal

15. Room Arrangement: Hypospadias Please use the shapes below as shortcuts for any new items. OR Table Surgeon Assistant Scrub Video Bovie Back table IV Pole Anesth Door to OR Circulator’s Computer Mayo Circulator Foot Pedal Patient’s head Text Extra Text

16. OR Protocols – Instrument Labels This section shows how to correctly set up the mayo stand or back table. It also shows the names of each instrument so that mistakes are avoided. On the following slide, please insert your own photo of your mayo stand or back table. Then use the blank labels to type in the correct names and position the labels appropriately.

17. Mayo Stand | Hypospadias Copy/Paste to re-use. The shape will change to fit the amount of text. Text Label Castro Viejo Needle Driver Weck Spears Bipolar Electrocautery with Needle Tip Mosquito x 2 Gnat x 4 Sharpie Tenotomy Wescott Straight Iris Adson x 2 0.12 Pickup 0.5 Pickup Raytec Marking Pen