116 terms

SURG 106: Surgical Procedures

STUDY
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Surgical Case Worksheet
A detailed decription of a procedure; A study tool completed the day before a case; completed daily or with every new case
Major Laparotomy Set
Includes retractors, forceps, clamps or hemostats and miscellaneous instrumentation used in general surgery
Vertical Midline Incisions
SImplest abdominal incision to perform
McBurney Incision
Most common for open appendectomy
Lower Oblique Inguinal Incision
Most common for open inguinal herniorrhaphy;
Subcostal Incision (Right Side)
Most commonly used for open procedures of the gallbladder, biliary system, and pancreas
Subcostal Incision (Left Side)
Most commonly used for surgery of the spleen
Subcostal Incision
Begins in the epigastrium, extending laterally and obliquely downward to just below the costal margin
Pfannenstiel Incision
Most commonly used for pelvic surgery as well as open obstetric and gynecological procedures
Midabdominal Transverse Incision
Used on the right or left for a retroperitoneal approach. This is standard incision for transverse colectomy or colostomy and choledochojejunostomy
Throacoabdominal Incision
Standard incision for surgery of the proximal stomach, distal esophagus and anterior spine
Hernia
Latin for "rupture" Greek for "Bud"
Hernia
A protrusion of a viscus through an opening in the wall of the cavity in which it is contained
Inguinal Hernia
A protrusion of part of the intestine through the lower abdominal wall into the inguinal region
Femoral Hernia
A protrusion of part of the intestin through the canal that carries the femoral artery into the upper thigh; most commin in women
Ventral Hernia
A hernia on the anterior abdominal wall at any point other than groin
Incisional Hernia
A hernia located at the site (incision) of a previous surgery
Diaohragmatic
Hernias in the diaphragmatic, usually at the esophageal hiatus; a hiatal hernia; occurs when the upper protion of the stomach protrudes through the hiatus, an opening in the diaphragm which the esophagus passes
Reducible Hernia
one that the herniated contents can be returned to its organic region via manual manipulation
Irreducible Hernia
Cannot be returned to its organic region via manual manipulation
Strangulated Hernia
one where the protruding organ has become constricted and its vascularity is compromised. Surgical Emergency.
Direct Hernia
An aquired hernia or one that results from a stressor such as trying to lift something too heavy
Indirect Hernia
A congenital defect in the internal inguinal ring
Principals of Hernia Surgery
Identify structures; Protect neural and vascular structures, Reduce the hernia, close defect (typically in a synthetic mesh)
Laparoscopic Nissen Fundoplication
Surgical procedure to correct a hiatal hernia and considered the preferred operative procedure
Blades of Laparoscopic Nissen Fundoplication
#11 or #15
Appendectomy
Performed for an acute appendicitis or incidentally during other surgery as a prophylactic measure
Biopsy
For diagnostic purposes
Lumpectomy/Segmental resection
Removal of breast mass without removal of surrounding tissue or removal of very little surrounding tissue (Breast conserving surgery)
Sentinel Lymph Node (SLN) Biopsy
Identification and microscopic examination of the sentinel node
Simple Mastectomy
Breast tissue and nipple removed, but lymph nodes left intact
Axillary Dissection
Provides for lymph node sampling and subsequent staging of disease
Modified Radical Mastectomy
Involves removal of the involved breast and all axillary contents (underlying pectoral muscles arent removed)
Radical Mastectomy
Involves remival of the involved breast, the underlying pectoral muscles and all axillary contents
Laparotomy
A surgical opening through the skin layer and abdominal wall into the peritoneal cavity
Exploratory Laparotomy may be done:
to check for injury to abdominal organs after trauma, to diagnose a cause for unexplained pain, for treatment of disease or injury to abdominal organs
Colon Resection
A section of the large intestine is removed and its continuity is restored; performed to remove cancerous lesions or areas of perforation.
Thyroidectomy
Surgical removal of one or more lobes of the thyroid gland; done to treat various diseases of the thyroid such as hyperthyroidism or cancer
Parathyroid glands
Closely related to the thryroid glands and must be spared during a thyroidectomy.
Oxytocin
Used to induce or continue labor, contract the uterus following delivery thereby controlling hemorrhaging, stimulate lactation, treat incomplete abortion, cause abortion, control uterine bleeding following abortion
Carboprost
Used to cause abortion by contracting the uterus and dilating the cervix, control uterine hemorrhage following abortion and childbirth
epiostomy
an intentional surgical incision of the vulva to ease the birth process, or to protect the mother from an uncontrolled perineal laceration; most common surgical intervention in vaginal birth
perineal laceration
an unintentional laceration of the perineal area due to the birthing process
Cesarean Section
surgical response to a failure of the normal birthing process
The most common reason for C-section
failure to progress or prolonged labor
Hysteroscopy
safe, quick inexpensive treatment for conditions including adhesions, polyps, submucous myomas; used for both diagnostic and operative purposes
Total Abdominal Hysterectomy (TAH)
Removal of the uterus via abdominal approach
Oophorectomy
Removal of the ovaries
Salpingectomy
Removal of the fallopian tubes
Total Abdominal Hysterectomy with Bilateral Salpingo-Oophorectomy (TAH-BSO)
Removal of the uterus, ovaries, and fallopian tubes
Vaginal Hysterectomy
Involves the same structures as the abdominal hysterectomy; however, the structures are encountered in the reverse order
TAH
Indicated for removal of the uterus and cervix due to malignancy, dysfunctional uterine bleeding, prolase, pain or disease, such as endometriosis, fibroids or cysts
TVH
Involes the same structures as the TAH however the structures are encountered in the reverse order
LAVH
Vaginal hysterectomy with certain steps performed through laparoscopic technique providing better visualization of internal structures
Laproscopic tubal
An effective permanent sterilization procedure
Laproscopic tubal
A permanent method of sterilization that in some states, requires the husbands consent
Tubal ligation: vaginal delivery
first or second postpartum day
Tubal ligation: cesarean delivery
tubes ligated at that time
Low-transverse
most common incision when performing a C-section
How do you arrange the instruments for a hysteroscopy?
Order of use, L to R
How is the cervix dilated during a Dilation & Curetage (D & C)?
Using a progressive series of dilators
What type of draping is used for a basic laparoscopy?
Laparotomy plus lithotomy and one time urethral cath prior to prep
What is a Salpingectomy?
Removal of part or all of the fallopian tubes
Normal Bone Healing
Inflammation, cellular proliferation, callus formation, ossification, remodeling
Interruptions (Bone Healing)
Poor immobilization of the fracture, distraction of bone fragments, deficient or nonexistent blood supply to bone, infection, interposition of soft tissue
Pneumatic tourniquets
aid in visualization of the surgical site by providing a bloodless surgical site
Maxi driver
used for large bones
Mini driver
used for small bones
Sagital saw
blade moves side to side
Oscillating saw
blade vibrates back and forth, it does not spin around
Reciprocating saw
blade more forward and backward
Reamers
used to enlarge the medullary canal of long bones
Major orthopedic set
used mainly for surgery on the large long bones, (femur and humerus) and for back surgery
Minor orthopedic set
Used mainly for soft tissue
Small bone set (hand/foot set)
used for procedures on smaller bones such as the tibia, fibula, radius, ulna and ankle
Fragmentation sets
used to repair fractures
Common orthopedic implants
screws, plates, wires, pins, intramedullary nails and rods and total joint components
Polymethyl Methacrylate
bone cement; used in total joint arthroplasty to stabilize and keep the implant in the correct anatomical position
Knee Arthroscopy
injuries or abnormalites within the joint such as torn meniscus and ligaments, loose bodies, damage from wear and tear
Bucket handle tear
most common meniscus tear
Bunionectomy
Removal of bony growth from the medial side of the first metatarsal head of the great toe (correct the deformity) and realign the great toe and to restore the normal range of motion
Fluoroscopy
used to confirm placement of the pins and that the reduction of the fracture is maintained during the External K-wire fixation of a colles fracture`
ORIF (humerus)
is indicated if fracture will not heal with closed reduction; if soft tissue injuries caused by the fracture are present and require treatment
how many muscles form a cuff around the shoulder joint?
4
ORIF (femur)
classified as a hip fracture
Shoulder arthroscopy
diagnostic tool for evaluating patients with chronic shoulder problems
Practical Consideration for shoulder arthroscopy
fluid may leak onto the floor during the procedure and the ST should anticipate the use of a device to suction up the water collecting on the floor
Suprarenal glands
also known as the adrenal glands; secrete hormones epinephrine and norepinephrine
Inguinal incision
used for radical orchiectomy
Scrotal incision
used for vasectomy, testicular biopsy, simple orchiectomy, orchiopexy
Abdominal incision
used for open cystostomy, supropubic prostatectomy
Gibson incision
an extraperitoneal abdominal approach specifically designed for access to the lower portion of the ureter
Flank incision
patient in the lateral position, these incisions provide access to the adrenal gland, kindey and proximal ureter
Lumbar incision
provides limited exposure, is used for adrenalectomy, renal biopsy, or removal of a small low-lying kidney
Adrenalectomy
to surgically remove one or both adrenal glands, performed because of a tumor, may also treat certain kinds of reproductive malignancies
Orchiectomy
removal of one or both testicles
Cystoscopy
Allows for visualization of structures with the main purpose being diagnosis
Simple nephrectomy
Total or partial removal of the kidney
The three main positions for GU
Lithotomy, Supine, Lateral
Gibson Incision
An extraperitoneal abdominal approach specifically designed for access to the lower portion of the ureter
Flank Incision
Lateral position; These incisions provide access to the adrenal gland, kidney, and proximal ureter
Lumbar Incision
Provides limited exposure, is used for adrenalectomy, renal biopsy, or removal of a small low-lying kidney
Endoscopic Removal
best for small non-malignant masses
Traditional Incisions
used for removal of large tumors and malignancies
Orchiectomy
Removal of one or both testicles
Radical Orchiectomy
Entire contents of hemiscrotum, tunica vaginalis, and spermatic cord removal, inguinal incisions
Simple Orchiectomy
Only testis and epididymis, scrotal incision
Cystoscopy
allows for visualization of structures with the main purpose being diagnosis
Simple nephrectomy
total or partial removal of the kidney, flank approach is incision of choice
Gerota's fascia
Layer of the kidney
Intake and output are measured how many hours post-op?
24-48 hours
Orchiopexy
surgical fixation of a testis in the scrotal sac; most commonly perfomed to treat torsion and to position a retracted testicle or one that has failed to descend
Practical considerations of an orchiopexy
performed bilaterally even if only one side is acutely affected
Transurethral Resection of Prostate (TURP)
Surgical removal of all or part of the prostate, suffering from Benign Prostatic Hypertrophy (BHP)
Ellik evacuators
removes fragments of the prostate
Irrigating solution for TURP shld be;
sterile, isotonic, nonelectrolytic, and at body temperature or slightly warmed