Autopsy: Evisceration Techniques

• autopsy suite = biohazard

  • keep contaminated material confined to the suite

• ensure proper ventilation with negative airflow exhaust system

• “clean” person to record measurements, weights, observations, photos, supplies

• begin with infectious case if performing 2

• universal precautions - attire, barriers, sharps, tissue fixation, decontamination, hand washing

  • scrubs, gowns, waterproof sleeves, aprons, hair nets, masks, goggles, shoe covers, gloves

  • 1 blade at a time, announce movements, place on the table to hand off, no blind cuts, blunt when possible

• deactivate defibrillators - document on internal and external exam

  • proper placement, wires connected/disrupted

  • proper removal - don’t want to incinerate if patient is being cremated

  • may be subject to tracking

• towels over the rib cage so don’t cut yourself

• patient is already dead! need to protect ourself

Understand the importance of safety precautions in the autopsy suite according to Connolly and as presented in lecture.

• in situ dissection of organs

• often erroneously referred to as Letulle

describe the rokitanksy evisceration technique

• may be performed in restrictive autopsy consent

• beneficial when time is severely limited

  • open and examine without removal

advantages of rokitanksy

• blind dissection

• no block removal

disadvantages of rokitansky

• removal of organs in regional and functional groups (en bloc)

• cervical, thoracic, abdominal, GU

describe ghon

• preservation of inter-organ relationship

• easier for one person

advantages of ghon

• transecting the esophagus and aorta at the diaphragm in cases of aortic dissection or aneurysm and esophageal varices or neoplasm

disadvantages of ghon

• removal of organs together in toto (en masse)

• block dissection takes place outside of the body

• hospital autopsies

describe letulle

• allows rapid prep for mortuary

• excellent preservation of interrelationships of various organs

• may offer greater safety because dissection outside confines of the body

advantages of letulle

• examination of organs may take longer

• may require assistants

disadvantages of letulle

• removal of organs one by one

• organs dissected individually outside of the body

• ME office

describe virchow

• excellent for demonstrating pathologic changes in organs

• faster and easier for prosector

advantages of virchow

• sacrifices inter-organ relationships

• interpretation of regional disease is more difficult

disadvantages of virchow

1. depending on the type of pathology, need to choose the best option to get the best info

2. may start with a plan to do one technique but have to change in order to perform the best examine

3. consent and what the family wants

   1. may need fast turn around for mortuary (letulle)

   2. restrictive consent (rokitansky)

4. limited staff (ghon easier for one person)

   1. virchow = faster and easier for 1 person

5. safer (letulle and virchow takes place outside of the body)

6. systemic process = take out everything together = Letulle

7. ME often virchow = sacrifices inter-organ relationships but great for demonstrating pathologic change in organs and fast

8. hospital often letulle because may be looking at more systemic processes or disease

discuss the importance of altering an evisceration technique to best suit the situation at hand as outlined in lecture