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There are certain surgeries that leave a mark on you, even after the patient has left the operating room.
DIEP (Deep Inferior Epigastric Perforator) is one of those surgeries for me.
Anytime I am assigned to a DIEP case, I know it’s going to be a long day.
These surgeries can go on for several hours and demand total focus from the surgical team.
But they are also rewarding and amongst the most satisfying procedures I have had the privilege to be part of.
These are not just surgeries; for many women, they are a vital part of the road to recovery from cancer and a chance to restore what was lost.
To play even a small part in this is something I will always treasure.
The Morning of a DIEP Procedure
The atmosphere in the operating room seems to change slightly on a DIEP day.
There is a calmness, but everyone is aware of the complexity of the procedure and the significance of the surgery for the patient.
Before we begin, we have our team briefing.
We go over the surgical plan, the patient’s requirements, equipment and any other relevant information.
I always appreciate these briefings as it is a good reminder that surgery is a team effort and success depends on everyone working together.
I prepare the operating room.
I set up and organise the instrument tables, prepare the suture packs, retractors and all the microsurgical instruments required for the procedure.
The venous coupler device is checked.
I double, triple and quadruple check everything in case I missed something.
When I did my first DIEP, I was petrified that I would miss something as I was quite inexperienced.
Now, after several DIEPs, I am still quite tense when it comes to this stage, but experience has taught me that preparation is key.
Working Together as Two Scrub Nurses
Another thing I appreciate about DIEP procedures is that there are always two scrub nurses.
One scrubs nurse will assist with the raising of the abdominal flap while the other prepares and assists with the breast reconstruction and microsurgery.
Although we work in different areas of the surgery, there is a constant communication between us.
Sometimes we just give each other a knowing look.
Often, we know what the other is going to do without having to say a word.
It is an unspoken bond that is established when you spend a lot of time working together in the operating room.
Meeting the Patient
One thing I find is always important in my role as a nurse is connecting with the patient.
Before any procedure, it is good to collect the patient.
Some patients are anxious.
Some are quiet.
Some will ask a lot of questions.
Others will just hold on tight to a family member’s hand before saying goodbye.
I remember one patient who looked absolutely terrified as we wheeled her into theatre.
Before she was put to sleep, I gave her hand a reassuring squeeze to let her know we would take good care of her.
It was a short moment, but it is one of the things I still think about as it reminds me that nursing is not only about the technical skills, but also about human kindness.
When the Surgery Begins
Once the patient is asleep, the theatre takes on a whole new energy.
We complete the WHO Surgical Safety Checklist, gown and glove up and start preparing the sterile field.
Preparation of the skin and draping is vital, although many might think it is a waste of time.
It is one of the most important steps in any procedure as we are putting the patient at risk of infection.
My Role During a DIEP Procedure
People always ask me what do scrub nurses do.
The answer is, quite a lot!
During a DIEP procedure, some of the many tasks I perform include:
- Preparing and organising sterile instruments
- Passing instruments throughout the surgical procedure
- Loading ligaclips and sutures
- Assisting with delicate microsurgical instruments
- Holding and protecting the flap if required
- Performing surgical counts with the circulating nurse
- Maintaining the sterile field throughout the procedure
One of my fondest memories is about the first time I was asked to hold the flap.
It didn’t come as a surprise as I knew the flap is quite heavy, but what came as a surprise was the look on my face as I was standing there thinking,
“Don’t move!”
I couldn’t move!
I couldn’t move but my arms were starting to ache.
What These Surgeries Have Taught Me
Each DIEP procedure has taught me something new.
I have learned to be a better person as I have learned to value patience and avoid impatience.
They have taught me to communicate more efficiently.
Sometimes, communication is not vocal. Sometimes, it is through knowing looks.
Above all, these procedures have taught me that I will forever learn from my experiences no matter how much experience I gain.
That, above all, is why I have chosen perioperative nursing.
Emotional Side of DIEP Reconstruction
Surgery is often seen as a technical field.
Being in the operating room has provided another insight into surgery, which is the emotional aspect of it.
Women who decide to have a DIEP procedure have already been though a lot.
They have been though cancer, the grief, the treatment, the stress and the anxiety.
This surgery is yet another hurdle to jump over and for many women it can be daunting and frightening.
However, being a part of giving them hope and helping them make this leap in their road to recovery is something I will always treasure.
Some days I leave work physically drained.
Other days, I leave work emotionally fulfilled that I am able to do what I do.
Why This Work Means So Much to Me
When I decided to go into operating theatre nursing, I had no idea that it would be such a wonderful experience.
Any surgery serves as a constant reminder of why I chose this career path.
I get to help people during one of the most vulnerable times in their lives.
I get to work with an incredible surgical team, and I get to help deliver something that can change a person’s life.
People rarely acknowledge the people behind a great surgery.
Patients may never look at me and say,
“Thank you for preparing my instruments and helping the surgeon.”
But knowing I played even a small part in a woman’s journey to recovery is something I will always cherish.
Learn More About DIEP Procedures
If you’d like to learn more about DIEP flap breast reconstruction, the Queen Victoria Hospital NHS Foundation Trust provides an excellent patient-friendly guide explaining how the procedure works and what patients can expect.
You can also explore my other operating room articles, including The Ultimate Guide to Surgical Instruments for Nurses, where I share many of the instruments commonly used in complex procedures like this.
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