Surgery

Learning objectives:

At the end of this chapter, you must able to know:

definition of surgery. why people need surgery. who needs to be operate. where surgery usually done. who are members of operation team. Classifications of surgery

Cont…

Consent form

Definition

Is invasive procedure whereby the surgeon will make skin incision (surgical cut) to gain entry to the internal organ to perform required task such as remove tumor, repair defect, stop bleeding, transplant new organ or ect

Why need surgery?

To save life Organ transplant Reduce pain Improve quality of life Cosmetic reasons

Who needs to be operated?

Any age group Anybody who has indication for

surgery as long Consent obtained Available equipment, surgeon and

operation room.

Where is surgery usually done? In operation room where equipment is

complete. Environment clean, minimal

contamination and quiet. Major, minor, endoscopic, ambulatory

operation room. At times client can be operated in the

ward treatment room. During emergency, a victim of trauma

operated at the scene of accident.

Who are members of operation team? Client Surgeon Anesthesiologist Anesthetist Nurse Operation Room Nurses Ward Nurses Support staff such as porter, technician

OR & CSSD.

Surgical procedures Abdominal Dental Oral & Maxillofacial Orthopedic General surgery Laparoscopic Plastic urology

Sexual reassignment.

Vascular Neuro Ororhinolaryngolog

y (ENT) Ophthalmic cardiothoracic

Terminology

1. Excision surgery: start with a name for the organ to be excised (cut out) and end in –ectomy.

Complete removal of organ, tissue or tumor from a body.

Example: appedicectomy hemorroidectomy

Cont…

2. Procedure involving cutting into an organ or tissue end in –otomy.

Example: laparotomy amniotomy broncotomy = laryngotomy

Cont…

3.Minimally invasive procedures involving small incisions through which an endoscope is inserted end in –oscopy

Example: bronchoscopy

Cont…

4. Procedures for formation of a permanent or semi-permanent opening called a stoma in the body end

-ostomy

Example: colostomy, sigmoidostomy, tracheostomy, ureterosigmoidostomy

Cont…

5. Reconstruction, plastic or cosmetic surgery of a body part starts with a name for the body part to be reconstructed and ends in –oplasty

Example: rhinoplasty

Cont…

6. Reparation of damaged or congenital abnormal structure ends in – rraphy

Example: herniorraphy perineorraphy

Classification of Surgery:

Based on:1. Priority.2. Risk3. Purpose4. Combination.

According to Priority

1. Elective

2. Urgent

3. Emergency

1. Elective surgery: Can be planned according to client,

surgeon availability.

If delayed or cancelled there will be no ill effect.

E.g cataract extraction, hemorroidectomy, face-lift, hip prosthesis.

2. Urgent surgery. Surgery need to be done soon but

not emergency.

To be done within 24-48hours.

E.g, removal of gallbladder, CABG, removal of malignant tumor, diabeticd amputation.

3. Emergency surgery Needs to be performed ASAP within a

hew hours.

To save life, a limb, hearing or sight.

E.g, to save injured eyes, to stp bleeding, repair of trauma, bleeding peptic ulcer, intestinal obstruction, tracheostomy.

According to Risk.

1. Minor surgery

2. Major surgery

1. Minor surgery Small and simple operation Low risk and minimal complication Can be performed as out

patient/ambulatory surgery. Done in treatment room in the

ward or doctors office. E.g arthroscopy, removal of warts,

Dilatstion & Curettage (D&C).

2. Major surgery Client needs to be admitted to the ward. Big and important surgery of major

organ. High-risk of post-operative complication. Can be life threatening. E.g Nephrectomy, Hysterectomy,

Mastectomy.

According to Purpose

a) Diagnostic: e.g breast biopsy, Laparoscopy, Bronchoscopy, Exploration, Laprotomy.

b) Ablative: to remove disease part of the body e.g Appendectomy, Subtotal Thyroidectomy, Colonectomy.

Cont…

c) Palliative: to relieve pain but not to cure.

e.g Colostomy, Arthroscopy, Angioplasty

d) Reconstructive: to return function or cosmetic reason

e.g Scar Revision, Plastic Surgery, Skin Grafting, Skin Reconstruction.

Cont..

e) Transplant: replacement of disease organ

e.g: kidney transplant, liver transplant, cornea and heart transplant.

f) Constructive: repair or correction defect

e.g: Repair of Cleft Lip & Palate, Closure of Atria- septal defect.

Consent

Is a legal written document to give an agreement to undergo both anesthesia and surgical procedure required for the diagnosis:

- Client must be > 18 years of age.- Conscious, alert and not confuse or

senile.

Cont…

Of sound mind and not under effect of sedative.

If under age to be signed by parents / guardian.

More about consent form. 3 signatures will be required in the

form. (surgeon,client/guardian and witnessed by attending nurse)

Client must explain regarding operation procedure, purpose of surgery, good effect to be achieved and the risks of the procedure clearly to client and family before obtaining the consent.

Cont… Attending nurse can help to

reinforce or simplify the explanation in simple terms to enhance client understanding.

Client has the right to refuse the surgery.

In cases of life threatening situation two specialist can give consent for surgery (surgeon & Anesthsiologist)

Our health always seems much more

valuable after we lose it.