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OR TECHNIQUE

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Title: OR TECHNIQUE


1
OR TECHNIQUE
2
Composition of OR team
  • Surgeon.
  • Assistants the surgeons.
  • Scrub nurse.
  • Circulating nurse.
  • Anesthetists.

3
Division of OR team
  • The sterile team includes
  • Surgeon.
  • Assistants to surgeons.
  • Scrub nurse.

4
Un-sterile team includes
  • Anesthesiologist.
  • Circulate nurse.
  • Others x-ray tech.

5
Scrub Nurse/Technician
  • Preoperative
  • Checks the card file for surgeon's special
    needs/requests.
  • Opens sterile supplies.
  • Scrubs, gowns, and gloves and sets up sterile
    field. Obtains instruments from flash autoclave
    if necessary. Checks for proper functioning of
    instruments/equipment.
  • Performs counts with circulator

6
Pre incision
  • Completes the final preparation of sterile field.
  • Assists surgeon with gowning/gloving.
  • Assists surgeon with draping and passes off
    suction / cautery lines.

7
During the Procedure
  • Maintains sterile field.
  • Anticipates the surgeon's needs (supplies/
    equipment).
  • Maintains internal count of sponges, needles and
    instruments.
  • Verifies tissue specimen with surgeon, and passes
    off to circulator.

8
Closing Phase
  • Counts with circulator at proper intervals.
  • Organizes closing suture and dressings.
  • Begins clean-up of used instruments.
  • Applies sterile dressings
  • Prepares for terminal cleaning of instruments and
    non disposable supplies.
  • Reports to charge nurse for next assignment.

9
Circulating Nurse
  • Preoperative
  • Assists in assembling needed supplies.
  • Opens sterile supplies.
  • Assists scrub in gowning.
  • Performs and records counts.
  • Admits patient to surgical suite.

10
Pre incision
  • Transports patient to procedure room.
  • Assists with the positioning of the patient.
  • Assists anesthesia during induction.
  • Performs skin prep.
  • Assists with drapes connects suction and cautery.

11
During the Procedure
  • Anticipates needs of surgical team.
  • Maintains record of supplies added.
  • Receives specimen and labels it correctly.
  • Maintains charges and O.R. records.
  • Continually monitors aseptic technique and
    patients needs.

12
Closing Phase
  • Counts with scrub at proper intervals.
  • Finalizes records and charges.
  • Begins clean-up of procedure room.
  • Applies tape.
  • Assists anesthesia in preparing patient for
    transfer to post anesthesia care unit PACU .
  • Takes patient to PACU with anesthesia and reports
    significant information to PACU nurse.
  • Disposes of specimen and records.
  • Reports to charge nurse for next assignment.

13
Circulate nurse
  • Duties of Circulating Nurse
  • Application of the nursing process in directing
    and coordinating all nursing activities and
    supporting the pt.
  • Maintaining the safe and comfortable environment
    for the pt. and the medical staff.
  • Assisting any members of the O.R. teams if
    needed.

14
  • Must know all supplies, instrument and equipment.
  • Identification of any environmental dangerous or
    stressful situation involving the pt. or other
    team members.
  • Maintain a good communication link between the
    O.R. team.
  • The circulate nurse is the most experienced
    nursing team members in the O.R. acts as
    supervisor, advisor and teacher.

15
Classification of surgery
  • Emergency without delay life threatening,
    immediate attention.
  • Urgent (Imperative) prompt attention (24-30h)
    acute GB stone, renal stone.
  • Required (planned) patient needs to have surgery
    (few weeks or months) as Cataracts.
  • Elective patient should be repair scars, simple
    hernia.
  • Optimal cosmetic surgery, individual preference.

16
Scrubbing techniques
  • Time Method 5 min.
  • Counting method

17
  • Basic positioning for
  • surgery

18
Supine Position and its
modifications.
  • Supine position.

19
Trendelenburg position.
20
Reverse Trendelenburg position.
21
Fowlers and Sitting position.
22
Lithotomy position.
23
Prone position and its
modifications.
  • Prone position.

24
Kraske (jackknife) position.
25
Knee-chest position.
26
Lateral position and its
modifications.
  • Lateral position.

27
Kidney position.
28
Sims position.
29
Fracture position
30
Preoperative Patient Routines
  • Surgical Consent
  • Nail polish
  • Sedation.
  • Diet (NPO 4-8 hr. )
  • Make up
  • Patient Identification
  • Lab. Tests

31
Technique for transferring the patient to OR table
  • For mobile pt. 2 of non sterile team
  • For immobile pt. 4 of non sterile team

32
Hypothermia
  • Hypothermia------?
  • post- operative shivering-----?
  • increase oxygen consumption up to 700.

33
Intra operative heat loss
  • Radiation loss of heat from the patients body
    to the environment.
  • Convection- loss of heat into the air currents.
  • conduction- loss of heat from the patients body
    into a cooler surface such as the operating
    table.
  • Evaporation- loss of heat via perspiration or
    respiration.

34
Principles of aseptic technique
  • Only sterile items are used within the sterile
    field.

35
Sterile persons are gowned and gloved Tables are
sterile only at table level
36
Sterile persons touch only sterile items or
areas
37
  • unsterile persons touch only unsterile items or
    areas.
  • Unsterile persons avoid reaching over sterile
    field
  • sterile persons avoid leaning over unsterile
    area.
  • Edges of anything that encloses sterile contents
    are considered unsterile

38
  • Sterile field is created as close as possible to
    time of use
  • Sterile areas are continuously kept in view
  • Sterile persons keep well within sterile area
  • Unsterile persons avoid sterile areas

39
Pathogens and infection
  • Pathogens associated with surgical site infection
    ( S.S.I.)
  • Bacteria.
  • Fungi
  • Viruse

40
  • The most commonly transmitted pathogen in O.R is
    Staphylococus Aureus (gram cocci).
  • Mycobacterium Tuberculosis- TB transmitted
    through airborne droplet nuclei. Infects lungs,
    kidneys, joints and skin.

41
Sources of Surgical Site Infection ( S.S.I. )
  • Normal flora of the patient.

42
2.Personnel.
43
3. Inanimate objects (contaminated
instruments).
44
4.Air borne contamination. 5.Contamination
during procedure (surg).
45
UNIVERSAL Precautions
  • Applied in an invasive procedure
  • PROTECTION
  • GLOVES

46
  • MASKS

47
  • EYEWEAR or FACE SHOELDS

48
  • GOWNS or APRONS

49
Prevention of puncture injuries
  • E.g. needles, knifes blades and sharp instruments
    present a potential hazards for the handler and
    user.
  • Do not manipulate by hand

50
  • Mouth protection- incase of emergency
  • Care of specimens- should be contained
  • Decontamination- all instruments must be cleaned
    before sterilization or disinfection.
  • Laundry- soiled linen should be handled as little
    as possible.
  • Waste - Blood and suctioned fluids .
  • Hand washing- following every contact with
    patient, blood and body fluids.

51
Cleaning, Disinfection and
Sterilization
52
Levels of disinfection
  • High level disinfection kills all
    microorganisms and may kill certain spores with
    sufficient contact time.
  • Intermediate level disinfection kills most
    microorganisms except spores.
  • Low level disinfection kills fungi, bacteria,
    and hydrophilic viruses.

53
Sterilization
  • Destruction of all microorganisms in or about an
    object as by steam, chemical agents, ultraviolet
    radiation.

54
Methods of Sterilization
  • Thermal.
  • Steam under pressure\ moist heat.
  • Hot air\dry heat.
  • Microwaves\ non ionizing radiation.
  • uv light ultraviolet light .

55
  • Chemical.
  • Ethylene oxide gas.
  • Formaldehyde gas.
  • Hydrogen peroxide plasma\vapor.
  • Ozone gas.
  • Glutaraldehyde activated solution.
  • Per acetic acid solution.

56
Ionizing radiation (physical).
57
  • Disinfectant and disinfectant/ sterilant agents.

58
High level disinfectant and sterility compounds
  • Glutaraldehyde (cidex)-
  • 2 concentration with PH of 7.5- 6.5, is a
    high level disinfectant.
  • 20 minutes for disinfection and 10 hours for
    sterilization.

59
  • Hydrogen peroxide 6.
  • Solution of 6 H2O2 with detergents and
    0.58 phosphoric acid have been proven to be
    parricidal with 6 hours of exposure at 20 degree.

60
  • Peracetic Acid (steris) sterilization.
  • This cycle usually takes 30 minutes.

61
  • Chlorine compounds.
  • - Chlorine compounds are effective against
    HIV, HBV and other viruses.

62
  • Formaldehyde.
  • It is bactericidal, psudomonacidal and
    fungicidal in 5minutes exposure, tuberculocidal
    and virucidal in 10-15 minutes, sporicidal in 12
    hours.

63
Intermediate level disinfectants.
  • Phenolic compounds- (phenol, carbolic acid).
  • Iodophors- (iodine, Polidine, Povidine)
  • Alcohol 50-90

64
Methods of monitoring the sterilization process
  • Mechanical Monitoring of parameters (time, temp,
    and pressure).
  • Chemical Internal and external indicator for
    steam and E.O.
  • Biological Is a device that contains a known
    number and specific type of microorganisms that
    are killed when exposed to the sterilizing
    conditions.

65
Homeostasis and Blood
Replacement
66
Methods of controlling bleeding during surgery
  • Mechanical methods.
  • 1- clamping or ligation or clipping the cut
  • vessels.

67
2-Sponges-Patties (cottonoids)
68
3- Pledgets-Teflon. 4- Bone wax- Bees
wax. 5- Suction, Drains. 6-
Tourniquet, Pressure devices .

69
  • Pharmacological Agents.
  • - Absorbable gelatin (gel foam).
  • - Collagen
  • - Oxidized cellulose (surgicel).
  • - Silver Nitrate (nasal bleeding).
  • - Epinephrine (vasoconstriction).
  • - Thrombin (enzyme).
  • Thermal Hemostasis.
  • - Elctrosurgery and Laser.

70
Blood Loss and Blood Replacement
  • Blood replacement can be
  • - Homologous- patients own blood.
  • - Autologus- from the same species.

71
Blood types and groups. - A, B, O, AB.
72
Methods of wound closure include
  • Sutures.
  • Staples.
  • Clips.
  • Tapes.
  • Glues
  • Suture - means ligation or approximating tissue
    together.

73
Methods of suturing
  • Everting sutures- skin edges.
  • 1. Simple continuous.
  • 2. Simple interrupted.

74
3. Continuous locking. 4. Horizontal
mattress. 5. Vertical mattress.
75
  • Inverting sutures- used for two layers
  • - Purse String Suture

76
.Tentions sutures
77
.Traction sutures - umbilical tape and
vessel loop
78
.Endoscopic suturing-
79
Kinds of sutures
  • Absorbable suture
  • -Natural
  • 1. Plain surgical gut

80
2. Chromic surgical gut- Is treated in a
chromium salt solution.
81
3. Collagen suture
82
  • Absorbable suture
  • - Synthetic
  • 1. Polydioxanone suture (PDS)

83
2. Poligleceprone( monocryl )
84
3. Polyglyconate (MAXON)
85
4. Polyglactin 910 (Vicryl)
86
5. Polyglycolic acid (Dexon)
87
6. Copolymer(Panacryl)
88
  • Non absorbable Suture
  • - Natural
  • 1. Surgical silk

89
2. Surgical stainless steel
90
  • Non absorbable Suture
  • - Synthetic
  • 1. Ethilon, Dermalon ( monofilament )

91
2. Nurolon ( multifilament uncoated )
92
3. srugilon ( multifilament coated )
93
4. NovafiL
94
5. Prolene
95
6. Ethibond
96
Kinds of Surgical staples
  • 1. Skin stapler

97
2. Intra luminal circular stapler (CEEA) Circular
End to End Anastomosis .
98
3. Ligating and dividing stapler ( GIA )
Gastro Intestinal Anastomosis. Roticulator.
99
4. Endo scopic stapler.
100
Tissue Adhesives
  • Biologic adhesives
  • - Fibrin glue.
  • - Autologous or homologous- plasma and
    clotting factors.
  • - Pooled donor plasma- multiple donors.

101
  • Synthetic adhesives-
  • - Cyanoacrylate glue- dries after 2 ½ minutes.
  • - Methyl methacrylate- used for fixation (bone
    cement).

102
Kinds of skin graft
  • Auto graft- skin is grafted from one part of the
    patient's body to another part.
  • Allograft -Human tissue is grafted to another
    person (from cadaver).
  • Xenograft- Skin obtained from a dissimilar
    species .
  • Artificial skin- synthetic skin

103
Terms Associated With Wound Healing
  • Adhesion - Band of scar tissue that holds or
    unites surfaces or structures together that are
    normally separated.

104
Contracture-Formation of extensive scar tissue
over a joint
Dead space - Space caused by separation of wound
edges or by air trapped between layers of tissue.
Debridement - Removal of damaged tissue and
cellular or other debris from a wound to promote
healing and to prevent infection.
105
Dehiscence - Partial or total splitting open or
separation of the layers of a wound.
106
  • Edema - Abnormal accumulation of fluid in
    interstitial spaces of tissues
  • Evisceration -Protrusion of viscera through an
    abdominal incision.

107
  • Extravasations- Passage of blood, serum, or lymph
    into tissues.
  • Exudate - Fluid, cells, or other substances that
    have been discharged from vessels or tissues.
  • Granulation tissue - Formation of fibrous
    collagen to fill the gap between the edges of a
    wound healing by contraction second intention .
  • Hematoma - Collection of extravasated blood in
    tissue.

108
  • Granuloma- Inflammatory lesion that forms around
    a foreign substance, such as glove powder or a
    suture Knot.
  • Homeostasis- Arrest of blood flow or hemorrhage,
    the mechanism is by coagulation (formation of a
    blood clot).
  • Incision- Intentional cut through intact tissue
    (synonym surgical incision).
  • Ischemia- Decrease of blood supply to tissues.

109
  • Necrosis- Death of tissue cells.
  • Scar- Deposition of fibrous connective tissue to
    bridge separated wound edges to restore
    continuity of tissues
  • Seroma- Collection of extravasated serum from
    interstitial tissue or a resolving hematoma in
    tissue.

110
  • Tensile strength- Ability of tissues to resist
    rupture.
  • Tissue reaction- Immune response of the body to
    tissue injury or foreign substances.
  • Wound disruption- Separation of wound edges.

111
Kinds of Drains
  • Passive drains- T- Tube, Foley catheter,
    enlarged bulbous ends (mushroom, malecot, pezzer
    catheters), pen rose.

112
Active drains Hemovac drain, sump drain, chest
drain.
113
Complications of wound healing
  • Hematoma/ Seroma
  • Scar/ Surgical
  • Adhesions
  • Postoperative wound disruption

114
Classification of Occupational hazards
  • Physical- back injury, fall, noise, pollution,
    irradiation, electricity and fire.
  • Chemical- including anesthetic gases, toxic fumes
    from gases and liquids, cytotoxic drugs, and
    cleaning agents.
  • Biologic- including the patient( as a host for or
    source of pathogenic microorganisms), infectious
    waste. Cuts, or needle stick injuries, surgical
    plume and latex sensitivity.

115
Ionizing Radiation
  • Radiation has cumulative effects
  • Sterile team members and others who can not
    leave room should stand 2 meters or more.
  • Staff members may request relief from exposure
    during pregnancy.
  • Lateral X-Ray more dangerous than Anterior
    Posterior ( AP ) X-Ray

116
SURGICAL SPECIALITIES
  • Endescopy Examination of a body part or cavity
    with an optical system in a tubular structure.
  • Insufflation Act of filling with gas.
  • Laparoscopy is performed with carbon
  • dioxide.
  • Laparoscopy Endoscope examination of the
    peritoneal body

117
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118
Hazards of endoscopy
  • Perforation- Major organ or vessel.
  • Bleeding- from biopsy site,
  • Hypothermia- CO2 is colder than body temp.
  • Infection- by microorganism

119
Breast procedures
  • Incision and drainage- surgical opening of an
    inflamed area because of infections in lactating
    breast.

120
Breast biopsy
  • Fine needle aspiration- 22-25 gauge needle
    attached to a syringe is inserted into the tumor
    mass.
  • Core biopsy-

121
Incisional biopsy- The mass is incised and a
portion is removed for histologic
examination. Excisional biopsy - The entire mass
is removed for pathologic study. Sentinel node
biopsy-In OR the tumor is injected with a dye
containing iso-sulfan blue that is taken up by
the lymph nodes of the breast.
122
Fiber optic ductoscopy-
A flexiable 0.9mm scope with a 0.2 mm working
channel is used in the ductal lumens of the
breast.
123
Lumpectomy
  • Partial mastectomy, consists of removal of
  • the entire tumor mass along with at least
  • 1 to 2 cm of surrounding non diseased tissue.
  • Done for tumor that measure less than
  • 5 cm.

124
Segmental mastectomy
  • a wedge of breast tissue is removed.

125
  • Simple mastectomy ( total mastectomy )- The
    entire breast is removed without lymph node
    dissection.

126
Modified radical mastectomy- Removal of the
entire breast along with all axillary lymph nodes.
127
Radical mastectomy- Removal of entire breast
along with the axillary lymph nodes, the pectoral
muscles and all adjacent tissues.
128
Extended radical mastectomy- The entire breast
is removed with the underlying pectoral muscles,
axillary contents, and upper internal mammary
lymph node chain.
129
Characteristics of the incision
  • Ease and speed of entry into the abdominal
    cavity.
  • Maximum exposure.
  • Least post operative discomfort.
  • Maximum post operative wound strength.

130
Types of abdominal incisions
  • Paramedian incision
  • Longitudinal midline incision
  • Subcostal upper quadrant oblique incision (
    Kocher )
  • Chevorn incision bilateral subcostal incision
  • McBurney incision
  • Thoracoabdominal incision

131
  • Mid abdominal Transverse incision
  • Pfannestiel incision
  • Inguinal incision

132
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133
Biliary Tract
134
  • Biliary Tract Procedures
  • Cholecysectomy is the removal of gallbladder

135
Choledochoscopy -
-Intra operative biliary endoscopy provides
image, transmission and illumination.
136
Cholelithotripsy-
Non invasive procedure in which high energy
shock waves are used to fragment
cholesterol gall stones.
Choledochostomy- A T-Tube is used to drain the
common bile duct through the abdominal
wall. Choledochotomy Is an incision of the
common bile duct.
137
Cholecystoduodenostomy- Cholecystojejnostomy
- Both performed to relieve an obstruction in the
distal end of the common duct. Anastomosis
between the gall bladder and duodenum or jejunum.
138
Choledochoduodenostomy- Choledochojejunostomy-
Are side to side anastomosis between duodenum or
jejunum and the common duct.
139
Splenic Procedures
  • Splenectomy
  • Splenorrhaphy

140
Pancreatic Procedures
  • Pancreaticojejunostomy
  • Pancreaticodudenectomy

141
Esophageal Procedures
  • Esophageal hiatal heniorrhaphy
  • Nissen fundoplication -360 degree
  • Toupet fundoplication 180-200

142
Gastrointestinal Surgery
  • Gastroscopy
  • Gatrostomy
  • Total Gastrectomy
  • Vagatomy
  • Pylroplasty
  • Gastrojejunostomy
  • Gastroplasty

143
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144
  • Gastric Bypass

145
Intestinal Procedures
  • colectomy
  • Ileostomy
  • Cecostomy
  • Colostomy
  • Appendectomy

146
Colorectal Procedures
  • Sigmoidscopy
  • Colonoscopy
  • Polypectomy

147
Complications of abdominal surgery
  • Pulmonary complications.
  • Fluid and electrolyte imbalance
  • Peritonitis and wound infection
  • Wound infection can cause wound disruption
  • Incisional hernia
  • Adhesions are the most common cause of post
    operative intestinal obstruction.

148
Anorectal procedures
  • Hemorrhoidectomy
  • Anal abscess
  • Fistulotomy and fistulectomy
  • Fissuerectomy
  • Pilonidal cyst and sinuses

149
Kinds of hernia
  • Inguinal hernia
  • Femoral hernia
  • Umbilical hernia
  • Ventral ( incisional ) hernia
  • Hiatal hernia

150
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151
Amputation of extremities
  • Reasons for amputation
  • Massive trauma.
  • Malignant tumor.
  • Extensive infection.
  • Vascular insufficiency.
  • Phantom limb pain- Is the sensation that the
    amputated part is still present.

152
Gynecologic and Obstetric Surgery
  • Colposcopy- Done for identification of abnormal
    epithelium to target for biopsy of the lower part
    of cervical canal and vaginal wall.

153
  • Culdocentesis- Blood, fluids and pus in the
    culdesac is aspirated by needle via the
    posterior vaginal fornix for suspected of intra
    peritoneal bleeding, ectopic pregnancy, trauma,
    and tumor.

154
  • Colpotomy- Transverse incision is made through
    the posterior vaginal fornix to facilitate
    diagnosis by intra peritoneal palpation,
    inspection of the pelvic organs or determination
    of fluids.

155
Fallopian tube diagnostic procedures
  • Hystosalpingography
  • Hysteroscopy and Laparscopy

156
Vaginal procedures
  • Vaginal lesion
  • Vaginectomy
  • Vaginoplasty
  • Vesicovaginal fistula
  • Rectovaginal fistula
  • Vaginal hysterectomy
  • Dilation and Evacuation (D E)
  • Dilation and Curettage ( D C )

157
Abdominal Procedures
  • Total Abdominal hysterectomy
  • Salpingo-Oophorectomy
  • Myomectomy
  • Ovarian cystectomy
  • Shirodkar and Cerclage procedures
  • Ectopic Pregnancy
  • Cesarean Section (CS)
  • In Vitro Fertilization (IVF)

158
Urologic Surgery
  • Surgical Procedures
  • Nephrectomy
  • Pyeloplasty- Revesion of the renal pelvis

159
  • Percutaneous Nephrolithotomy, Nephrolithotripsy
    PCNL
  • Ultrasonic lithotripsy
  • Electrohydrolic lithotripsy
  • Nephrolithotomy or pyelolithotomy

160
  • Extracorporeal shock wave lithotripsy (ESWL)
  • Ureteroscopy
  • Percutaneous Uretrolithotomy
  • Ureterolithotomy- An open procedure for the
    removal of stones from the ureter.
  • Cystolithotomy and cystolitholapaxy- Removal of
    bladder stone, crushing a urinary stone in the
    bladder.
  • Cystoscopy
  • Cystotomy or Cystoplasty
  • Cystectomy

161
  • Urethrotomy-cut into a urethral stricture
  • Urethroplasty
  • Orchiectomy
  • Testicular Torsion
  • Hydrocelectomy
  • Varcocelectomy
  • Vasectomy
  • Transurethral Resection of Prostate (TURP)
  • Suprapubic Prostatectomy

162
Sings of TUR syndrome
  • Mental confusion.
  • Nausea and vomiting.
  • Hypertension followed by hypotension.
  • Symptoms of fluid over load and pulmonary edema.
  • Bradycardia and dysrhthmia.
  • Visual disturbances.
  • Seizures and twitching.
  • Coma.

163
Treatment of TUR syndrome
  • Administration of IV hyper tonic saline
  • Monitoring of serum sodium levels
  • Diuretics

164
Orthopedic Surgery
  • Steps of bone healing
  • Hematoma formation.
  • Callus formation, 1-2 weeks.
  • Calcification process, completed by 6 weeks.
  • - Remodeling phase, 6 months to 1 year.

165
Indications for orthopedic surgery
  • Fracture of bones.
  • Reconstruction of joints.
  • Repair of tendons and ligaments

166
Kinds of fractures
  • Traumatic fracture- may be closed or open
    fracture.
  • Pathologic fracture- due to demineralization of
    bone (osteoporosis or the aging process).

167
Methods of treating fractures
  • Closed reduction with immbolization
  • Skeletal traction
  • External fixation
  • Internal fixation
  • Electrostimulation

168
Arthrodesis
  • Fusion of a joint may be achieved by removing the
    articular surface and securing bony implant that
    inhibits motion.

169
Arthroplasty
  • It is done to
  • Restore or improve range of motion
  • Provide stability
  • Relieve pain.

170
  • Arthroscopy
  • Arthrotomy
  • Bunionectomy Hallux valgus It is done to remove
    a painful exotosis or to functionally or
    cosmetically correct the deformity.
  • Neurolysis
  • Meniscectomy

171
Neurosurgery
  • Craniotomy
  • Cranioplasty
  • Epidural hematoma Bleeding caused by rupture or
    tear of the middle meningeal artery or its
    branches forms a hematoma between the skull and
    the dura
  • Subdural hematoma Bleeding between the dura matar
    and arachnoid is caused by laceration of viens
    that cross the subdural space.

172
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173
  • Laminectomy
  • Diskectomy - discectomy

174
  • Spinal fixation

175
Ophthalmic Surgery
  • Ophthalmic drugs
  • Mydriatic drugs used to dilate the pupil.
  • Miotic drugs used to constrict the pupil.

176
Ocular surgical procedures
  • Extra ocular procedures- are conditions
    affecting the exterior surface of the eye.
  • Chalazion an extremely common but benign tumor
    of the lid, it can be malignant.
  • Correction of pitosis is a drooping of the upper
    lid
  • Ectropin is a condition in which either the
    upper or the lower lid is everted ( turned out).
  • Entropin is a condition in which either the
    upper or the lower lid is enverted (turned in).

177
Lacrimal apparatus
  • Lacrimal duct dilation Probing
  • Dacryocystectomy removal of the lacrimal sac due
    to chronic inflammation.
  • Dacryocystorhinostomy (DCR) construction of a
    new opening into the nasal cavity from the
    lacrimal sac

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Extra ocular muscle
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  • squint
  • Procedure on the oculomotor muscles which
    control eye movement, are done to correct
    misalignment that interferes with the ability of
    the two eyes to remain in simultaneous focus on a
    viewed object.

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ORBIT
  • Enculation
  • is the complete removal of the eyeball,
    severing of its muscular attachments. The muscle
    stumps are preserved. Over lying fascia and
    conjunctiva are closed to hold the prosthesis in
    the socket.

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  • Evisceration
  • is the removal of the contents of the eyeball
    only, the outer sclera and muscles are left
    intact.
  • Exenteration
  • is the removal of entire eye and orbital
    contents including tendon, fatty and fibrous
    tissue. It is done incase of malignant tumor of
    the lid or eyeball.

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Intra Ocular procedures
  • Pterygium it is benign growth of the
    conjunctival tissue over the corneal surface.
  • Corneal transplantation (Keratoplasty)
  • Cataract Is an opacification of the crystalline
    lens, its capsule or both
  • Extra capsular cataract Extraction (ECCE)
  • Implantation of intraocular lens (IOL)

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  • Vitrectomy It is the removal of a portion of the
    vitrous humor (vitrous body) that fills the space
    between the lens and the retina

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Vascular Surgery
  • The vein has valve and carry deoxygenated blood.
  • The artery has no valve and carry oxygenated
    blood.
  • Thrombectomy and embolectomy A fogarty catheter
    is inserted proximally and advanced into a vessel
    distally beyond the obstruction.The balloon on
    the tip is then inflated. As the catheter is
    withdrawn, thrombotic or embolic material is
    removed to restore blood flow to an extremity.

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Vascular surgical procedures
  • Femoropopliteal bypass
  • Aneurysmectomy
  • -Kinds of aneurysm
  • 1.Fusiform aneurysm
  • 2.Saccular aneurysm

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  • The most common affected vessels in an aneurysm
  • Abdominal aorta.
  • Thoracic aorta.
  • Aortic arch.
  • Popliteal arteries.

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Venous stasis disease
  • When the valves of the veins fail to function
    normally, increased backpressure of blood causes
    the veins to become dilated-----? Varicose Vein.
  • Rx-Ligation and stripping of varicose veins

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  • Fasciotomy
  • is the treatment of choice for the
    prevention of compartment syndromes after acute
    ischemia in the upper or lower extremity.

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  • Vascular shunts
  • Arterio venous shunts and fistulas
  • Anastomosis at the wrist between the radial
    artery and cephalic vein.
  • Loop fistula may be created with a graft from the
    brachial artery to the cephalic or basilica vein.

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Plastic and Reconstructive Surgery
  • Aesthetic procedures
  • Blepharoplasty- correct deformities of the upper
    or lower eyelids of one or both eyes
  • Otoplasty- repair of deformity of one or both
    external ears of an adult
  • Rhinoplasty- reshaping of the nose.

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  • Mentoplasty- the shape and size of the chin can
    be altered for aesthetic and functional bite
    disorders.
  • Rhytidoplasty- face lift.
  • Liposuction- localized areas of fat deposits are
    removed by suction assisted lipectomy.
  • Abdominoplasty- includes excising excess lax
    abdominal wall skin and adipose tissue and
    tightening abdominal wall musculature.

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ENT, HEAD, and NECK SURGERY
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The ear consists of three parts
  • External ear consists of auricle (pinna),
    external auditory canal, tympanic membrane
    (eardrum).
  • Middle ear consists of Tympanic cavity , a
    closed chamber that lies between the tympanic
    membrane and the inner ear inside the cavity
    there is a three small bones, the ossicular
  • chain ( malleus, incus, stapes) they
    resemble the hammer, anvil, and stirrups.

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  • Inner ear The two main sections are the cochlear
    and vestibular
  • Potential complications of ear infection
  • Facial paralysis.
  • Meningitis.
  • Intracranial infection (brain abscess).

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Surgical procedures of the ear
  • External ear procedure
  • Removal of a foreign body from the outer canal
    usually in children
  • drainage of hematoma due to injury
  • Excision of tumor- pinnectomy

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  • Middle ear procedures
  • Mastoidectomy- the eradication of mastoid air
    cells done to relieve complications of acute or
    chronic complications.
  • Tympanoplasty it refers to any procedure
    performed to repair defects in the eardrum or
    middle air structures for the purpose of
    reconstructing sound conduction paths.
  • Stapedectomy Partial or total removal of the
    stapes.

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  • Inner ear procedure
  • -Implantation of cochlear prosthesis
  • A cochlear implant can restore perception of
    sound to patients who have performed sesorineural
    deafness not responsive to external amplification
    of hearing aids.

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Nose
  • Turbinectomy- removal of turbinate.
  • Polypectomy-
  • Septoplasty-
  • Rhinoplasty- correction of deformity of the nose.
  • FESS- functional endoscopic sinus surgery
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