Introduction to Surgical Procedures PDF

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Summary

different surgical procedures and how they are done and instruments that are used in these procedures ...

Description

Introduction to Surgical Procedures Suffixes relating to surgical procedures and their definitions          

Centesis- to puncture in order to aspirate Desis- binding or fixation Ectomy- excision, surgical removal Lithotomy- incision for removal of stones Oscopy- inspection/examination through a lighted scope Ostomy- creation of a new opening for drainage Otomy- incision into Pexy- suspension or fixation Plasty-repair or surgical reconstruction of Rraphy- suture or repair

Primary goal of surgical intervention 

To allow the patient to be able to return to his/her best possible state of physical and mental health o it is recognized that not every patient will return to a state of wellness due to the nature of some terminal illnesses. In the cases, the health team members will work together to ease the patient’s pain and discomfort

Reasons for surgical intervention    

prophylactic (preventative)- to prevent the occurrence of a disease or illness restorative (curative)- to regain the patients health and strength palliative- to relive or alleviate symptoms, without curing the underlying cause or disease diagnostic- to investigate and identify the cause or nature of a condition, illness or disease

Types of surgical complications     

infection respiratory distress cardiac arrest hemorrhage procedure or equipment mishaps o incorrect sponge count, malfunctioning equipment

Common abdominal incisions 

vertical o median or midline  this is the simplest abdominal incision. It provides excellent abdominal exposure and is easily extended  upper  lower o paramedian rectus- parallel and approximately 4 cm lateral to the midline

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right or left upper right of left lower

oblique o McBurney, muscle splitting (right) o Subcostal (Kocher)  Right  Left o Lower oblique inguinal  Right  Left Thoraco-abdominal o Right o Left  For this incision, the patient is in lateral position. It extends from a point between the xiphoid and umbilicus across the abdomen to the 7th or 8th intercostal space and into the thorax Transverse o Midabdominal  Right  Left o Pfannenstiel

Abdominal incisions and their common uses             

Upper median- stomach, duodenum, pancreas Lower median- uterus, bladder, lower intestine Right upper paramedian- stomach, duodenum, pancreas Left upper paramedian- spleen, stomach Right lower paramedian- pelvic structures, proximal colon Left lower paramedian- pelvic structures, distal colon McBurney- appendix Right subcostal- gallbladder, biliary system Left subcostal- spleen Lower oblique inguinal (left or right)- inguinal hernia repairs Thoraco- abdominal (left or right)- upper stomach, lower esophagus Midabdominal transverse (left or right)- stomach, pancreas, biliary system Pfannenstiel- uterus, ovaries, uterine (fallopian) tubes

Layers of abdominal tissues     

Skin Subcutaneous Fascia Muscle Peritoneum

Definitions  

Laparotomy- an incision made through the abdominal wall into the peritoneal cavity Exploratory laparotomy- an incision made through the abdominal wall into the peritoneal cavity as a diagnostic procedure, without knowing the exact nature of the patient’s condition or disease

Duties of the surg tech in an exploratory laparotomy 

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Preoperative o Pull basic set up from surgeon’s preference card, open sterile items and prepare the initial sterile field o Scrub, gown, and glove o Drape back table o Drape mayo o Set up mayo o Count sponges, needles, and instruments with circulator (1st count) o Gown and glove surgeon and assistants o Drape according to surgeon’s preference o Move mayo to field o Secure cords to drape o Place lap sponges on each side of the proposed incision site Intraoperative o Skin and subcutaneous- pass scalpel and be prepared to pass hemostats, free ties, or bovie or forceps o Fascia- pass scalpel and be prepared to pass retractors and replace sponges as needed o Muscle- pass scalpel and prepare for entrance into the peritoneum  Dip lap sponges in warm saline and wring out  Have self-retaining retractor ready  Ensure RPs are not on field o Peritoneum- pass hemostats, knife, and or Metz o Pass retractor and saline moistened laps to protect the skin edges Perform following duties as needed o Keep the field clear of instruments not in use o Keep the bovie free of debris o Exchange soiled sponges for clean ones o Keep loose items such as needles, small dissecting sponges, and suture wrappers off the mayo stand o Protect the field form contamination o Anticipate the needs of the surgeon o Notify the surgeon of a break in technique if occurs o Complete procedure as pathology indicates and care for specimen if needed o Assist with irrigation according to surgeon’s preference o Counts sponges, sharps and instruments according to policy

Pass clamps, sutures, and retractors according to surgeon’s preference and assist in cutting suture ties if needed Postoperative o Assist in removing excess blood around incision and place dressing over wound o Remove drapes and covers on the light handles o Assist in moving patient to post-anesthesia recovery cart o Clean room  Discard sharps according to policy o

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The uses of lasers in surgery   

Laser is an acronym for Light Amplification by Stimulated Emission of Radiation Lasers are devices that use the natural oscillations of atoms or molecules between energy levels for generating coherent electromagnetic radiation Radiant energy (radiation) produces both light and heat o Laser light may be in ultraviolet, visible or infrared regions of the light spectrum o Laser heat can be useful on surgical applications for cutting, coagulation, and vaporizing tissue

Lasers   

Surgical lasers are delicate and expensive and must be handled with care Special safety precautions must be followed when lasers are being used Laser surgery offers several advantages o Improved hemostasis o Improved precision, especially when coupled to the operating microscope o Decreased postoperative edema, pain and scaring o Decreased operative time o Avoidance of possible hospitalization o Uncomplicated wound healing

Types of lasers Lasers are named by the medium in the laser activity  Argon (active medium: argon ion gas) o Operates in the visible light region in the blue green spectrum o Is easily delivered to the tissue through flexible fiberoptic and can be coupled to the operating microscope, hand probe, or through a variety of endoscopes o Argon laser energy is primarily absorbed in tissue by hemoglobin and melanin o Used primarily to destroy skin lesions with minimal scarring, coagulate superficial vessels in GI tract, and to treat retinal detachments and hemorrhages o Used in ophthalmology, otolaryngology, gynecology, urology, neurology and dermatology  CO2 (active medium: CO2, nitrogen, and helium gases) o Operates in the middle of the infrared portion of the spectrum emitting and invisible beam

CO2 lasers use a red aiming beam to focus on the tissue to be irradiated Is delivered to the tissue coupled to the operating microscope or with the aid of articulating mirrors and hand probes o CO2 laser emissions are heavily absorbed by water o The vaporization and hemostatic actions of the CO2 laser is valuable in treating soft tissue and vascular lesions o Primarily used in otolaryngology, gynecology, plastic surgery, dermatology, neurosurgery, orthopedics, and cardiovascular and general surgery Krypton (active medium: Krypton ion gas) o Operates in the visible light spectrum emitting a red-yellow light beam o Absorbed by pigment found in blood and retinal epithelium o Resembles the argon laser in construction and use o Delivered through fiberoptics, microscopes, handpieces, and endoscopes o Primarily used in opthamology Nd: YAG (yttrium-aluminum-garnet doped with 1%-3% of neodymium [Nd] ions) o Operates in the near (low) infrared spectrum emitting an invisible beam o Is delivered to the tissue by flexible fiberoptics, and is either coupled to a hand probe for focusing or is used alone with an endoscope o Its penetration into tissue is very deep. It is the most powerful coagulator of all surgical lasers capable of vaproizing large volumes of tissue o It is poorly absorbed by hemoglobin and water but is intensely absorbed by tissue protein o Has applications in neurosurgery, urology, rhinolaryngology, gynecology, general surgery, orthopedics, and thoracic surgical procedures KTP (active medium: Potassium titanyl phosphate) o Sometimes known as frequency doubled YAG o Operates in the visible spectrum emitting a green beam o Is delivered to the tissue through a microscope or a flexible fiber o Produces less power than a CO2 or Nd: YAG laser but can be focused to a smaller diameter o Strongly absorbed by hemoglobin, melanin, and similar pigments and is transmitted through clear fluids o Can adapt to any surgical specialty using the wide variety of accessories Holmium: YAG (active medium: Holmium, thulium and chromium) o Operates in the mid-infrared (orange) portion of the spectrum emitting an invisible beam o Delivered to the tissue through a flexible fiber o Penetrates less deeply into tissue than Nd: YAG with greater precision in cutting and less heating of tissue o Absorbed by tissue containing water o Used primarily for orthopedics, neurology, and general surgical procedures Ruby (active medium: Ruby crystal) o Emits a visible red light o o

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Delivered to the tissue by a fiber or through a microscope Blood vessels and transparent substances do not absorb this beam Is capable of generating large amounts of energy on impact which can injure internal tissues and bone o Used originally in opthalmology but now primarily used in dermatology to remove port-wine stains (birthmark) Excimer (active medium: Halide, argon, fluoride) o Emits a visible blue-green beam o Produces “cool” energy o Offers precision in cutting and coagulation without thermal damage to surrounding tissue o Currently being developed for use in opthalmology, peripheral and coronary angioplasty, neurosurgery, and orthopedics o o o

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Laser system parts   

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Excitation source- Provides energy to the laser head to produce laser light Laser head- Contains the active medium to energize and produce the laser energy Ancillary components- Additional laser parts required to produce laser energy o Console- Protective housing for laser components o Cooling system- Keep the laser head from overheating Control panel- Source of laser operation controlling the wattage and duration Delivery system- Attachment that transmits the laser energy to the tissue from the laser head

Precautions for using lasers 

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Patient safety precautions o Noncombustible anesthetic agents should be used o Nonflammable antiseptic should be used for skin prep o Patient’s eyes should be protected by a double layer of moistened eye pads for the CO2 laser and by goggles, protective lenses, or metal shields for other lasers o Patient’s exposed skin and mucous membranes outside the surgical field should be protected by a double layer of moistened surgical towels o When used, endotracheal tubes must be protected from direct and reflected laser beam irradiation to prevent catastrophic airway fires by wrapping the tubes with reflective metal tape and by placing water-saturated neurosurgical cottonoids below the vocal cords Personnel safety precautions o All operating room personnel should wear protective glasses. Clear glass goggles will suffice with the CO2 laser, while special colored lenses should be worn by all present for other lasers o Protect skin o Avoid inhalation of laser plume Environmental safety precautions o Warning signs should be posted on all doors to control access

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Walls and ceilings should have a non-reflective surface Any windows must be covered Warning labels must indicate points of danger to avoid personnel exposure to laser radiation Check machine for proper functioning Machine should be kept on standby setting when not in use during the surgical procedure Monitor the laser foot switch Use non-reflective instruments A basin of water should be available in case of fire Electrical codes must be enforced Follow manufacturers instructions for operation, care, handling, and sterilization procedures...