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Surgical Specialties DR - Paghubasan

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SURGICAL SPECIALTIES • Extreme care should be taken to observe

(Endoscopy and Robotic-Assisted Surgery) patients after e scopic procedures for effects
Dr. Jonathan M. Paghubasan of respiratory or circulatory system distress
caused by gas absorption, trauma, or
ENDOSCOPY medication.
Access Portal into the Body
• Natural orifice or functional stoma
• Puncture or incision

Knowledge and Skill for a Safe Endoscopic


Environment
• Attributes of the Endoscopic Team- The
attributes of the team members complement
each other within their own scope of practice. GENERAL SURGERY
Together, they provide the knowledge and • Special Considerations for General Surgery
skill necessary for the safe and effective • A central core of knowledge and skills
performance of an endoscopic procedure. common to all surgical specialties (e.g.,
• Attributes of the Surgeon- surgeon must anatomy, physiology, metabolism,
have an expert knowledge of anatomy and pathology, immunology, wound healing,
physiology shock and resuscitation, neoplasia, and
nutrition)
• The diagnosis and preoperative,
intraoperative, and p tive care of patients with
diseases of the alimentary tract; the
abdomen and its contents; breast; head and
neck; endocrine system; and vascular
system (excluding intracranial vessels, the
heart, and vessels intrinsic and immediately
Hazards of Endoscopy adjacent thereto)
• Perforation • Responsibility for the comprehensive
• Bleeding management of trauma and critically ill
• Hypothermia patients with underlying surgical conditions
• Preperitoneal insufflation
• Gas embolism BREAST PROCEDURES
• Incidental iatrogenic injury- Improperly • Incision and Drainage- Surgical opening of
grounded electrical equipment, Unsuspected an inflamed and suppurative area is most
current leaks often carried out because of infections in the
Considerations for Patient Safety lactating breast.
• The patient should be monitored for signs • Breast Biopsy- Fine-needle aspiration,
and symptoms of reaction to drugs. Core biopsy, Stereotactic breast biopsy,
Incisional biopsy, Excisional biopsy, Sentinel
• A topical agent is frequently applied to nasal
node biopsy, J-wire or needle localization in
or oral and pharyngeal mucosa before
radiology department, Fiberoptic ductoscopy
introduction of an endoscope into the
tracheobronchial tree or gastrointestinal tract • Lumpectomy- a partial mastectomy,
consists of removal of the entire tumor mass
• The teeth, gums, and lips are protected if the
along with at least 1 to 2 cm of surrounding
endoscope is introduced through the mouth.
nondiseased tissue.
Dentures are removed
• Segmental Mastectomy- a wedge or
• Hydrogen and methane gases are normally
quadrant ( tomy) of breast tissue is removed;
present in the colon. These gases are
this wedge includes the tumor mass and the
flushed out with carbon dioxide before laser
lobe in which it is growing.
surgery or electrosurgery through the
colonoscope to avoid the possibility of • Simple Mastectomy- the entire breast is
explosion within the colon. removed without lymph node dissection.
• Power sources and lights should be tested • Modified Radical Mastectomy- usually
before each use and after cleaning performed for i trating ductal and localized
small malignant lesions. The term modified
• The heat generated from the projection lamp
encompasses various techniques, but all
of a fiberoptic illuminator is dissipated.
include removal of the entire breast (total
• Endoscopes should be smooth, with no nicks
on the surface

D.JUAN
mastectomy). In addition, all axillary lymph • Cholecystoduodenostomy and
nodes are resected. cholecystojejunostomy are bypass
• Radical Mastectomy- the entire involved procedures to avoid further obstructive
breast is removed along with the axillary jaundice, but they do not solve the problem
lymph nodes, the pectoral muscles, and all • Choledochoduodenostomy and
adjacent tissues. choledochojejunostomy are side-to-side
• Extended Radical Mastectomy- The anastomoses between the duodenum or
involved breast is removed en bloc along jejunum and the common duct.
with the underlying pectoral muscles, axillary
contents, and upper internal mammary
(mediastinal) lymph node chain. This
procedure is more difficult than a classic
radical mastectomy.

LIVER PROCEDURES
• Liver Needle Biopsy- percutaneous needle
biopsy may help establish a diagnosis of liver
disease
• Drainage of Subphrenic and Subhepatic
Abscesses- these abscesses are treated by
incision and drainage. A catheter may be
introduced into the abscess cavity, which has
been localized on a CT scan.
• Intraoperative Hepatic Ultrasound- used
to identify anatomic sutures or liver densities
associated with a primary tumor or
metastasis.
• Hepatic Resection- Lobectomy or
segmental resection is indicated for cysts,
benign or malignant tumors, or severe
penetrating or blunt trauma.
• Portosystemic Shunts- A portosystemic
shunt is a vascular anastomosis between the
portal and systemic venous systems.

SPLENIC PROCEDURES
• Splenectomy- The most common reason
for removal of the spleen is hypersplenism—
overactivity that causes a reduction in the
circulating quantity of red cells, white cells,
platelets, or a combination of them.
• Splenorrhaphy- The spleen can then be
sutured or stapled along the edge of a partial
splenectomy.

PANCREATIC PROCEDURES
ABDOMINAL PROCEDURES
• Pancreaticojejunostomy- These methods
• Biliary Tract Procedures involve a tomosing a loop of the jejunum
• Cholecystectomy- removal of the (Roux-en-Y loop) to the pancreatic duct.
gallbladder. (Open Abdominal Hemorrhage and leakage of bile are
Cholecystectomy., Laparoscopic complications to be avoided.
Cholecystectomy.) • Pancreaticoduodenectomy (Whipple
• Common Bile Duct Exploration- Procedure)- Pancreaticoduodenectomy is
Concomitant exploration of the common an extensive procedure performed on
duct. Intraoperative Cholangiograms., patients with carcinoma of the head of the
Ultrasonography, Choledochoscopy, pancreas or the ampulla of Vater. l include
Cholelithotripsy, Choledochostomy and anastomosis of the pancreatic duct, c mon
Choledochotomy bile duct, stomach, and jejunum.
• Cholecystoduodenostomy and • Pancreatectomy- performed to resect a
Cholecystojejunostomy- Through benign tumor or for chronic pancreatitis. The
anastomosis, these procedures establish c distal tail is resected to the head of the
ity between the gallbladder and either the pancreas.
duodenum or jejunum. • Pancreaticoduodenal Trauma- A midline
incision is used to explore the abdomen.

D.JUAN
Suturing to control bleeding, debridement of
devitalized tissue, and draining are the initial
therapies.

ESOPHAGEAL PROCEDURES
• Esophageal Hiatal Herniorrhaphy- When
intraabdominal pressure exceeds pressure
in the chest, the abdominal esophagus and a
portion of the stomach may slide through the
esophageal hiatus and into the thoracic INTESTINAL PROCEDURES
cavity. • Resection of the Small Intestine- An
• Esophagogastrectomy- Removal of the abdominal incision is made over the
lower portion of the esophagus and proximal suspected or known site of disease. After
stomach may be indicated to resect exposure, clamps are placed above and
malignant tumors, benign strictures, or below the diseased segment of the bowel
perforations at or near the esophagogastric and mesentery to avoid spillage. The
junction involved area is resected, and an end-to-end,
• Surgical Procedures for Esophageal end-to-side, or side-to-side anastomosis is
Varices- Sclerotherapy is usually attempted performed to restore continuity.
before more radical procedures are • Hemicolectomy, Transverse Colectomy,
performed. The lower esophagus may be Anterior Resection, and Total Colectomy-
transected and the distal segment Most surgical p cedures involve opening the
anastomosed with a circular stapler just abdomen, walling off the peritoneal cavity,
proximal to the stomach. incising and clamping at the points where
resection is to be carried out, and, finally,
GASTROINTESTINAL SURGERY reestablishing continuity by anastomosis.
• Gastroscopy- Gastroscopy involves the • Intestinal Stomas- is a surgically created
passage of a flexible fiberoptic gastroscope. opening, or stoma, that extends from a
This procedure is usually performed while portion of the bowel to the exterior via the
the patient is sedated, with a topical abdominal wall.
anesthetic applied in the oropharynx to • Ileostomy- the proximal end of the
control the gag reflex. transected ileum is exteriorized through the
• Gastrostomy- Establishment of a temporary abdominal wall.
or permanent opening in the stomach may be • Cecostomy- an opening is created in the
indicated for gastrointestinal decompression cecum and a tube is inserted for
or to provide alimentation for a prolonged decompression of the massive distention
period when nutrition cannot be maintained caused by colonic obstruction.
by other means. • Colostomy- An opening anywhere along the
• Gastric Resections- Total Gastrectomy, length of the colon to the exterior skin surface
Subtotal Gastrectomy( billroth procedure) creates an artificial anus
• Vagotomy- Vagotomy, the division of the
vagus nerves, may be recommended to
interrupt vagal nerve impulses, thus lowering
the production of gastric hydrochloric acid
and hastening gastric emptying. Vagotomy
can be performed at
• several different locations along the course
of the vagus nerve
• Bariatric Surgery- Bariatric surgery can be
performed as an open abdominal surgery or
as a laparoscopic procedure. The surgical
landmarks are altered in obese patients
because the body habitus is large and
extends beyond the borders of the average-
sized patient. Insufflation via Veress needle
may not be performed at the umbilicus.
(Gastroplasty,Gastric Bypass.)

D.JUAN
APPENDECTOMY determine indications for surgical
• The open abdominal approach involves a intervention.
muscle-splitting incision in the right lower • Peritoneal Lavage- The peritoneal lavage
quadrant, over McBurney’s point. The blood procedure is done under local anesthesia by
supply to the appendix is ligated and creating a 2-cm midline incision in one of two
severed. A crushing clamp is applied to the planes: infraumbilical or supraumbilical (if the
appendiceal base, which is then ligated and patient is pregnant or has a fractured pelvis).
severed from the cecum. • Emergency Exploratory Laparotomy- The
• After creation of a peritoneal working space surgeon makes a midline incision from
with carbon dioxide (CO2 ), trocars are xyphoid to pubis in some cases. The surgeon
placed, the laparoscope is inserted through carefully displaces the abdominal contents
the infraumbilical incision, and the patient is laterally to examine each angle of the
placed in individual organs.

LAPAROSCOPIC APPENDECTOMY
• Trendelenburg’s position. Secondary trocars
are inserted in the suprapubic area and left
lower quadrant for placement of graspers
and dissectors. The appendix is located and
hemostatically dissected from the
mesoappendix with endoscopic clips or
staples. Endoloop ligatures are placed at the COMPLICATIONS OF ABDOMINAL SURGERY
base of the appendix, and endoscopic • Patients are particularly prone to pulmonary
scissors are used to transect. complications after abdominal surgery.
• subject to a variety of fluid and electrolyte
imbalances because they generally have a
nothing-by-mouth (NPO) status
postoperatively.
• Peritonitis and wound infection may result
after gastrointestinal surgery because of
spillage of contaminants from the lumen of
COLLATERAL PROCEDURES the gastrointestinal tract.
• Sigmoidoscopy- direct visual inspection of • Escherichia coli and Bacteroides fragilis are
the sigmoid and rectal lumens by means of a the most common organisms; Clostridium
flexible fiberoptic or rigid lighted perfringens, the chief cause of gas
sigmoidoscope. gangrene, can be found in the intestinal
• Colonoscopy- provides visual inspection of tract.
the lining of the entire colon. • Adhesions are the most common cause of
• Polypectomy- usually performed through a f postoperative intestinal obstruction.
tic colonoscope. Polyps, which are often
familial, may be single or multiple and are OTHER ABDOMINAL SURGICAL PROCEDURE
easily excised at the base. The colonoscope • Anorectal Procedures
may be used intraoperatively to locate • Anoscopy, Proctoscopy, and Sigmoidoscopy
polyps. • Hemorrhoidectomy
• Abdominoperineal Resection- (also known • Incision and Drainage of an Anal Abscess
as the Miles procedure) is a radical type of • Fistulotomy and Fistulectomy
colectomy and excision of the rectum and • Fissurectomy
anus performed for colon cancer or extreme • Excision of Pilonidal Cysts and Sinuses
inflammatory disease.
• Hernia Procedures
• Low Anterior Colon Resection- With this
• Inguinal Herniorrhaphy
technique for low anterior colorectal
• Femoral Herniorrhaphy
anastomosis, colorectal continuity is restored
and anal sphincter control is maintained • Umbilical Herniorrhaphy
without necessitating a permanent • Ventral (Incisional) Herniorrhaphy
colostomy; with an abdominoperineal • Hiatal (Diaphragmatic) Herniorrhaphy
resection, a permanent colostomy is • Amputation of Extremities
necessary. • Amputations of the Lower Extremity
• Amputations of the Upper Extremity
ABDOMINAL TRAUMA • Rehabilitation
• Systematic Approach to Evaluation- When
dealing with abdominal trauma patients, the GYNECOLOGIC and OBSTETRIC SURGERY
first thought is hemorrhage or fecal spill. Gynecology: General Considerations
Severe penetrating trauma can be • The emotional preparation of gynecologic
complicated by evisceration. patients presents a special challenge to the
Ultrasonography, x-ray, and CT scan are OR team.
useful presurgical diagnostic tests to assess • Anticipation of physical exposure, potential
the extent of abdominal injuries and to loss of sexual function, infertility problems, or

D.JUAN
termination of pregnancy can create severe • Culdoscopy- culdoscope is introduced into
anxiety. the peritoneal cavity via the p terior vaginal
• Some surgical procedures terminate fornix and pouch of Douglas. Some
reproductive capability and produce gynecologists prefer culdoscopy to
menopause. investigate ovaries or posterior surfaces in
• Patients must be able to express concerns, the lower pelvis.
ask questions, and receive reassurance and • Hysteroscopy- rigid fiberoptic
support hysteroscope, introduced vaginally through
the uterine cervix, provides direct inspection
of the interior of the uterus to diagnose
disease or treat conditions such as
menorrhagia and uterine fibroids
• Laparoscopy

VULVULAR PROCEDURES
• Total Vulvectomy- Basal cell carcinoma
usually does not metastasize but is often
locally extensive and prone to recur.
Treatment consists of wide total vulvectomy,
also without node dissection.
• Radical Vulvectomy with Bilateral
DIAGNOSTIC TECHNIQUES Inguinal-Femoral Lymphadenectomy-
• pelvic examination includes inspection and Radical vulvectomy is performed for invasive
palpation of the external genitalia; bimanual vulvar cancers or melanoma and is usually
abdominovaginal and abdominorectal done in one stage. Resection lines may vary
palpation of the uterus, fallopian tubes, and depending on the location and size of the
ovaries; and speculum examination of the lesion
vagina and cervix
• Papanicolaou (Pap) smear has significantly
facilitated diagnosis of cervical cancer and
premalignant lesions.
• Schiller test involves staining the vaginal
vault and cervical squamous epithelium with
Lugol’s solution.
• Biopsy of the Cervix- Excisional Biopsy,
Incisional Biopsy, Cone Biopsy.
• Fractional Curettage- Tissue is obtained for VAGINAL PROCEDURES
histologic examination by scraping the • Vaginectomy- Vaginectomy (partial or
uterine cavity. Fractional curettage complete) is performed for carcinoma in situ
differentiates specimens between the or carcinoma of the vagina.
endocervix and the endometrium in a series • Vaginoplasty- vagina may be constructed in
of two steps. patients with congenital absence of the
• Colposcopy- Illumination and binocular vagina (Rokitansky syndrome) or, more
magnification afforded by the commonly, in those with stenosis after
colpomicroscope permit identification of radiation therapy or after surgical removal of
abnormal epithelium to target for biopsy. the vagina.
• Culdocentesis- blood, fluid, or pus in the
cul-de-sac is aspirated by needle via the
posterior vaginal fornix for suspected
intraperitoneal bleeding, ectopic pregnancy,
or tub ovarian abscess.
• Posterior Colpotomy- a transverse incision
is made through the posterior vaginal fornix UTERUS
into the posterior cul-de-sac to facilitate • Dilation and Curettage- The most
diagnosis by intraperitoneal palpation, frequently performed gynecologic procedure,
inspection of the pelvic organs, or dilation and curettage (D&C) is done for
determination of free fluid, blood, or pus in diagnostic and/or therapeutic purposes. The
the pouch of Douglas. procedure is performed for women with
• Tubal Perfusion postmenopausal bleeding or symptoms
• Tubal Insufflation- Uterotubal insufflation suggestive of endometrial cancer, even
may be used to test the patency of the when cytologic smear findings are negative.
fallopian tubes. It usually is done as an office • Intrauterine Thermal Balloon Ablation-
procedure to study infertility. specialized electrically heated latex balloon
• Hysterosalpingography- X-ray study of the probe can be induced into the uterine cavity
uterus and tubes may afford further through the cervical os to treat menorrhagia
evaluation of infertility after repeated • Vaginal Hysterectomy- performed for
negative Rubin test findings. severe uterine prolapse or prolapse

D.JUAN
accompanied by stress incontinence and for prevesical space, the urethra and bladder
patients with pelvic relaxation or a history of neck are suspended to the posterior border
myomas, irregular uterine bleeding, or a of the symphysis pubis.
treated premalignant lesion. ABORTION
• Cerclage- Cerclage is not usually performed
after 26 weeks’ gestation because the cervix
is often too short to support suturing. Most
cerclage is performed as an ambulatory
procedure.
• Suction Curettage- Intrauterine contents
can be aspirated for elective voluntary
abortion or for incomplete natural abortion
(spontaneous abortion) within the first 20
weeks of pregnancy.

ABDOMINAL PROCEDURES UROLOGIC SURGERY


• hysteroplasty Surgical Procedures of the Genitourinary
• Myomectomy- myomectomy, single or System
multiple fibroid tumors are removed from the • Nephrectomy- Removal of a lobe or the
uterine wall in premenopausal women who entire kidney is indicated when tumor,
may still desire pregnancy. disease, or traumatic injury has resulted in
• Abdominal Hysterectomy- The entire the absence of renal function. The entire
uterus, including the cervix, is resected. kidney can be removed during a
Normal ovaries are preserved for hormone laparoscopic procedure. Hand-assisted
production whenever possible in women laparoscopy (HALS) can use used.
younger than 45 years. • Nephrostomy or Pyelostomy- An incision
• Pelvic Exenteration- anterior exenteration through the renal parenchyma or into the
the reproductive organs, the distal part of the renal pelvis may be necessary to establish
ureters, the bladder, and the vagina are temporary or permanent drainage when an
removed. Posterior exenteration removes obstruction prevents the flow of urine from
the reproductive organs, sigmoid colon, and the kidney
rectum. • Pyeloplasty- Revision or reconstruction of
the renal pelvis is performed to relieve an
anatomic obstruction in the flow of urine by
creating a larger outlet from the renal pelvis
into the ureter.
• Renal Revascularization- Stenotic lesions
of renal arteries are surgically correctable
causes of hypertension. Renovascular
reconstructive procedures (renal
angioplasty) are designed either to improve
FALLOPIAN TUBE AND OVARIAN blood flow through the stenotic area to the
PROCEDURES kidney or bypass the stenotic area.
• Tubal Ligation for Reproductive • Dialysis- The treatment modality alleviates
Sterilization- Ligation may be performed the acute manifestations of uremia and
through a small transverse incision in the controls many of the chronic long-term
pubic hairline area. An infraumbilical incision complications of end stage renal disease.
is used for postpartum patients. This is • Nephrolithotomy or Pyelolithotomy- A
referred to as minilaparotomy. nephroscope may be used during the
• Salpingostomy- salpingostomy creates an surgical p dure for direct visual examination
opening in a distally obstructed tube. of the nephrons to locate and remove
• Salpingolysis residual calculi.
• Tubal Anastomosis - A proximal obstruction • Extracorporeal Shock-Wave Lithotripsy-
in the tube is resected Shock waves delivered directly over the
• Salpingectomy and Salpingo- kidney may injure the renal tissue causing
oophorectomy the development of hypertension or chronic
• Ovarian Cystectomy renal disease.
• Oophorectomy • Ureteroscopy— These scopes are
• Urinary Stress Incontinence Procedures- introduced percutaneously or c cally.
Urinary stress incontinence is the sudden, Biopsies of tumors can be performed, and
involuntary, and intermittent release of urine strictures can be corrected by balloon
as a result of muscular changes around the dilation.
proximal urethra, bladder neck, and bladder • Ureterolithotomy- If the calculus is high in
base. the ureter near the kidney, the patient is
• Marshall-Marchetti-Krantz Vesicourethral positioned for a lateral flank incision below
Suspension- After mobilization through an the twelfth rib. An abdominal incision is used
extraperitoneal abdominal approach into the

D.JUAN
to reach a calculus in the lower segment near ORTHOPEDIC SURGERY
the bladder. • Closed Reduction- A fracture may be
• Cystoscopy- Cysto is a visual examination manipulated (set) to replace the bone in its
of the interior walls and contents of the proper alignment without opening the skin.
bladder. This technique is referred to as a closed
• Suprapubic Cystostomy- With a reduction (CR).
suprapubic cystostomy, urinary drainage • Skeletal Traction- Traction is the pulling
from the bladder is established via a catheter force exerted to maintain proper alignment or
inserted through a suprapubic incision or position. In skeletal traction the force is
trocar puncture into the bladder. applied directly on the bone after insertion of
• Cystectomy- In a cystectomy, the bladder is pins, wires, or tongs placed through or into
removed for invasive malignant disease. The the bone.
bladder can be removed by an open • External Fixation- are used for the
procedure or by robot-assisted laparoscopy. treatment of selected types of skeletal
• Urethroplasty- Reestablishment of injuries, especially to the pelvis and
continuity without stricture is the ultimate extremities, with marked soft tissue loss and
objective after a traumatic urethral injury and instability.
is usually associated with pelvic fractures in • Open Reduction and Internal Fixation
males. (ORIF)- exposes the fracture site for
• Orchiectomy- In this procedure, bilateral realignment under direct visualization;
oblique incisions in the inguinal canals closed reduction sometimes precedes the
extend into the upper anterior surface of the insertion of an internal fixation device. The
scrotum over the testes. The testes are fracture is reduced to align fragments.
removed from the scrotum after ligation of • Arthrodesis- Fusion of a joint may be
the spermatic cords at the external or internal achieved by removing the articular surfaces
inguinal rings. and securing bony union or by inserting a
• Vasectomy- In a vasectomy, a segment of fixation implant that inhibits motion.
each vas deferens is removed and sent to Arthrodesis may be performed after
the pathology department in individually resection of a recurrent benign, potentially
labeled specimen cups malignant, or malignant lesion that involves
• Vasovasostomy- Recannulization of the the ends of the bones and joint.
vas deferens for the restoration of fertility • Arthroplasty- Arthroplasty (reconstruction
requires an unobstructed anastomosis. The of a joint) may be necessary to restore or
vas deferens has a tough 2-mm outer improve range of motion and stability or
diameter and an inner diameter of 1 mm or relieve pain. This may be done by
less at the distal end, as well as dilation at resurfacing, reshaping, or replacing the
the proximal end. articular surfaces of the bones.
• Transurethral Prostatectomy- • Arthroscopy- visualization of the interior of
Transurethral resection, also referred to as a joint through an arthroscope, allows
transurethral resection of the prostate diagnosis and conservative treatment of
(TURP), involves the removal of all or part of some cartilaginous, ligamentous, synovial,
the glandular tissue within the prostatic and bony surface defects.
capsule by electroresection through the • Arthrotomy- (i.e., incision into a joint) may
urethra be necessary to remove bone or cartilage
• Adult Male Circumcision- Difficulty in the fragments or to repair a defect in the
retraction of the foreskin is referred to as synovium or joint capsule. Synovectomy may
phimosis. Paraphimosis occurs when the be the procedure of choice for relief of pain
foreskin retracts to expose the glans and and control of inflammation in a rheumatoid
cannot be repositioned back. These arthritic joint.
conditions may necessitate circumcision or • Cast Application- A cast is a rigid form of
removal of the foreskin to prevent necrosis dressing used to encase and support a part
and gangrene. of the body. It supports and immobilizes the
• Penectomy- The penis may be partially or part in optimum position until healing takes
completely resected because of neoplasm or place. A cast usually includes the joints
trauma. A partial penectomy may allow the above and below the affected area.
patient enough length for upright voiding.
Cosmetic reconstruction may be possible in COMPLICATIONS AFTER ORTHOPEDIC
some patients. Invasive disease may SURGERY
necessitate a complete penectomy, including ▪ Embolus- Fat embolism is possible after
removal of the scrotum and testes fracture of a long bone or crush injury.
(orchiectomy). Thromboemboli can result from deep vein
• Penile Prosthesis- Implantation of a penile thrombosis, causing pulmonary emboli. Any
prosthesis as treatment for organic vessel wall injury can cause this event.
impotence can enable some men to achieve Rarely a bolus of bone cement can enter the
a satisfactory return of sexual activity within venous system and travel to the patient’s
4 to 6 weeks postoperatively. lungs.

D.JUAN
▪ Compartment Syndrome- Edema, • Corneal Transplantation (Keratoplasty)- a
hematoma, and seroma may form between damaged cornea is removed and replaced
tissue layers of the fascial plane, causing with a healthy cornea from a human donor.
compartment syndrome. The pressure from • Extracapsular Extraction- the lens is
prolonged swelling results in further tissue delivered through a small incision in the
destruction and necrosis that can lead to region of the limbus (the junction of the
toxicity and death cornea and sclera).
• Intracapsular Extraction- The entire lens,
NEUROSURGERY OF THE BRAIN AND intact within its capsule, is delivered through
PERIPHERAL NERVES a moderate-sized incision made in the region
of the limbus. Before delivery, an iridectomy
or multiple iridotomies are performed, chiefly
to prevent iris prolapse and to preserve
communication between the anterior and
posterior chambers.
• Repair of Detached Retina- Reattachment
is effected only by surgical intervention. The
retinal defect is sealed off, and often the
subretinal fluid is drained. The specific
procedure used to achieve retinal
reattachment is determined by the type and
location of the detachment.the
• Vitrectomy- Vitrectomy is the deliberate
removal of a portion of the vitreous humor,
also called vitreous body, that fills the space
between the lens and the retina.
Therapeutically it is performed for vitreal
opacities, vitreal hemorrhage, and certain
types of retinal damage or detachment. In
addition to other causes, endophthalmitis
Surgical Procedures of the Cranium (i.e., inflammation of the internal tissues of
▪ Craniectomy- removal (-ectomy) of a portion the eyeball) and the presence of an
of the bones of the skull (cranium). intraocular foreign body may result in vitreal
▪ Craniotomy- Scalp, bone, and dural flaps opacity.
are raised to expose a large area of the PLASTIC AND RECONSTRUCTIVE SURGERY
cerebrum for exploration, definitive • Skin and Tissue Grafting- Denuded areas
treatment, or excision of lesions within the of the body are resurfaced by transplanting
brain. or transferring segments of skin and other
▪ Cranioplasty- Traumatic or surgically tissues from an uninjured area (donor site) to
created skull defects are corrected with the injured area (recipient site). The plastic
autogenous bone grafts or a synthetic or surgeon prefers to transfer tissues of
titanium prosthesis. Large defects in the compatible color, texture, thickness, and
anterior or middle fossae are covered for hair-bearing characteristics.
protection of the brain and for cosmetic • Pedicle Flaps- The pedicle, which is the
effect. attachment of elevated tissue to the donor
site, must contain a vascular bundle to
OPHTHALMIC SURGERY maintain blood supply to the tissue. Pedicle
• Blepharoplasty- redundant folds of skin and flaps are constructed from several types of
herniated pockets of fat are removed, and tissues and sources of vascular bundles.
defects in the muscle layer are repaired Nasal reconstruction is commonly done this
• Enucleation- complete removal of the e ball way
and the severing of its muscular • Replantation of Amputated Parts-
attachments. The muscle stumps are Replantation may be attempted to salvage a
preserved, with the space between the traumatically amputated digit, hand, or entire
stumps forming a pocket for the spherical upper extremity. A severed foot or lower
plastic artificial eye extremity presents more formidable
• Evisceration- removes the contents of the problems because of the functional necessity
eyeball only; the outer sclera and muscles for weight bearing
are left intact for attachment to a prosthesis. • Soft Tissue Reconstruction- This
This procedure reduces the danger of technique ensures consistent skin color,
transmitting an intraocular infection to the texture, and hair-bearing characteristics.
orbit and brain. • Blepharoplasty- Redundant skin and/or
• Exenteration- removal of the entire eye and protruding orbital fat is excised to correct
orbital contents, including tendon, fatty, and deformities of the upper or lower eyelids of
fibrous tissues. This procedure is performed one or both eyes. Blepharochalasis (loss of
for a malignant tumor of the lids or eyeball elasticity of the skin of the eyelids) can occur
that has extended into the orbit. at any age and usually is of unknown cause

D.JUAN
• Rhinoplasty - Reshaping of the nose, • Adenoidectomy- removal of hypertrophied
although usually performed for cosmetic adenoid tissue from the nasopharynx and
alteration desired by the patient, may be behind the posterior choanae, may be
necessary to correct defects caused by performed in adults to relieve upper airway
trauma or surgical resection of neoplasms obstruction. This is more commonly
• Hair Replacement - Hair follicles can be performed in children, often to prevent
transplanted from the posterior aspect of the recurrent otitis media. Adenoid tissue usually
scalp to bald or balding areas. Hundreds of atrophies after adolescence.
micrografts (4 mm) and minigrafts (4.5 mm) • Tonsillectomy - Chronically infected or
are implanted in staged rows over the entire hypertrophied tonsils are most frequently
bald area to change the hairline. removed in childhood.
• Liposuction - A blunt, hollow, curved or • Gingivectomy - Portions of the gingiva,
straight metal cannula (Mercedes cannula) mucous membrane, and underlying soft
measuring 1.5 to 6 mm with multiple tissue that covers the alveolar process and
openings in the distal shaft connected to a surrounds the teeth are excised to remove
suction machine is inserted through small deep pockets of plaque, calculus, and
skin incisions inflamed soft tissue.
• Augmentation Mammoplasty - Inflatable • Tracheotomy and Tracheostomy-
implants are inserted under breast tissue or Tracheotomy is an incision into the trachea
the underlying pectoralis muscles and then below the larynx. Tracheostomy is the
filled with sterile saline solution through self- formation of an opening into the trachea
sealing valves. where a tube is inserted to help the patient
breathe.
OTORHINOLARYNGOLOGIC AND HEAD AND • Thyroidectomy- During all thyroidectomy
NECK SURGERY procedures, care is exercised not to damage
• Removal of a Foreign Body- Removing a the laryngeal nerves and parathyroid glands.
foreign body from the outer canal is • Radical Neck Dissection- This procedure
performed most frequently in children. The gives the patient with cancer of the cervical
object is washed out or removed to prevent lymphatic chain a chance for cure and arrest
purulent infection of spread. When metastasis is known to be
• Mastoidectomy- the eradication of mastoid present or is highly suspected because of the
air cells, may be indicated to relieve location or stage of the malignancy, the
complications of acute or chronic mastoiditis. surgical procedure is predicated on the
Mastoidectomy is more commonly assumption that metastases are regional and
performed in conjunction with a not distant.
reconstructive procedure. • Resection of Nasal or Paranasal Sinus
• Tympanoplasty - refers to any procedure Tumors- Radical craniofacial resection may
performed to repair defects in the eardrum be indicated to remove gigantic benign nasal
and/ or middle ear structures for the purpose dermoid tumors and malignant tumors of the
of reconstructing sound conduction paths. paranasal sinuses. In a one-stage
• Labyrinthectomy- vestibular labyrinth is procedure, all involved soft tissue is excised
removed from the inner ear to correct with simultaneous correction of the
incapacitating vertigo. This results in loss of underlying skeletal structure.
vestibular function and hearing. • Reduction of Nasal Fractures- Fracture of
• Turbinectomy- Chronic engorgement of the the nasal bones and septum often
middle and/or inferior turbinate causes nasal accompanies other trauma to the head, such
congestion and rhinorrhea. Rhinitis is as a blowout fracture of the orbit (see earlier).
frequently an allergic reaction. If the zygoma or maxilla is involved,
• Polypectomy- Polyps usually are bilateral, reduction may be accomplished through a
but they may be unilateral, single or multiple, small incision anterior to the ear and superior
and they frequently are infected. In addition to the zygomatic arch.
to obstructing ventilation, they may obstruct • Intermaxillary Fixation of Fractures- After
the sense of smell if the olfactory epithelium closed or open reduction, fractures of the
is blocked. maxilla and mandible are usually
• Rhinoplasty- procedure to correct deformity immobilized by interdental wiring if the
of the nose, may be performed by a patient has upper and lower teeth.
rhinologist or a plastic surgeon. It is a major • Mandibular Fractures- Some fractures of
procedure involving reconstruction and the mandible can be immobilized by transoral
molding of the bones and cartilages placement of noncompression miniplates.
• Parotidectomy- excision of a parotid gland, This technique obviates the necessity of
is performed through an incision in the neck interdental wiring. Vitallium, titanium, or
below the angle of the mandible and stainless steel plates and screws are used
extending upward to one or both sides of the for rigid fixation.
ear
• Total Glossectomy- All of the tongue and
often the floor of the mouth are resected

D.JUAN
THORACIC SURGERY mediastinoscope or computed tomography
• Mediastinoscopy- Mediastinoscopy (CT)guided percutaneous needle.
uncovers mediastinal lymph nodes for direct • Transsternal Bilateral Thoracotomy—
visualization and biopsy. This incision is referred to as a clamshell and
• Thoracostomy- Closed thoracostomy is is mostly used for bilateral lung transplants.
performed to establish continuous drainage This incision is less commonly used and
of fluid from the chest (usually purulent from causes more discomfort for the patient.
sepsis or drainage of blood) or to aid in • Anterolateral or Posterolateral
restoring negative pressure in the thoracic Thoracotomy- Anterolateral or
cavity. It involves insertion of a tube through posterolateral incisions may be preferred for
an intercostal space via a trocar and cannula. some cardiac procedures such as valve
• Thoracoscopy- Thoracoscopy provides procedures.
visualization of the pleural space, parietal
and visceral pleurae, mediastinum, CARDIAC SURGICAL PROCEDURES
pericardium, and thoracic wall. • Cardiopulmonary Bypass- CPB is the
• Extracorporeal Membrane Oxygenator- technique of oxygenating and perfusing
An extracorporeal membrane oxygenator blood by means of a mechanical pump-
(ECMO) is used as a resuscitative device for oxygenator system. This apparatus
adults or children who have potentially temporarily substitutes for the function of the
reversible respiratory and/or cardiac failure. patient’s heart and lungs during cardiac
8 It also is commonly used to prolong surgery. CPB is used for most intracardiac
extracorporeal circulation when the patient is (open heart) and coronary artery procedures.
in distress after removal from • Components of a Bypass System-
cardiopulmonary bypass. Oxygenator, Heat Exchanger, Pump,
• Thoracotomy- An incision through the Perfusion, De-airing.
thoracic wall (i.e., thoracotomy) is indicated • Restorative Valve Procedures- Restorative
for drainage of pleural spaces, exploration of and reparative valve surgery is the preferred
the thoracic cavity, or cardiac and pulmonary procedure for most valve diseases.
procedures. Thoracic surgical procedures, Valvuloplasty and a plasty are valve-sparing
exclusive of cardiac procedures, include procedures to maintain structural integrity
exploratory thoracotomy, open thoracotomy, and ventricular function.
and open chest drainage. • Valve Replacement- Mechanical Valves,
• Lung Resection- Generally the indications Biologic Valves, Mitral Valve Replacement,
are neoplasms; e matous blebs; and fungal Aortic Valve Replacement..
infection, localized residual lung abscess, • Coronary Artery Bypass Graft- For
tuberculosis, and/or bronchiectasis resistant coronary artery bypass grafting (CABG),
to nonsurgical treatment. 9Neoplasms are single or multiple arterial bypasses are done,
the predominant indication. depending on the number of vessels affected
• Thoracentesis- Air or blood in the pleural and the degree of obstruction present.
cavity may be detected on x-ray and • Coronary Artery Angioplasty- Coronary
aspirated by a needle and syringe. A chest artery angioplasty procedures usually are
tube may be inserted into the pleural space performed in the cardiac catheterization
percutaneously for closed thoracostomy laboratory (cath lab) or special interventional
drainage. If bleeding persists, the chest is procedures room in the radiology
opened and vessels are ligated or repaired. department.
COMPLICATIONS • Percutaneous Transluminal Coronary
• Continuous movement of the chest causes Angioplasty.- performed under fluoroscopy
postoperative pain. with image intensification. Balloon dilation of
• The plan of care should include preoperative the coronary arteries may be the procedure
teaching of breathing techniques to assist the of choice for select patients with significant
patient in clearing airway secretions. atherosclerotic narrowing in a major coronary
• Chylothorax, the leakage of chyle from the artery
thoracic duct of the lymphatic system into the • Laser Angioplasty- An argon laser probe, a
pleural space, is a potential complication of neodymium:yttrium aluminum garnet
thoracic surgery. (Nd:YAG) optical fiber, or a pulsed excimer
laser may be used for laser angioplasty.
CARDIAC SURGERY • Intracoronary Stent- A stent may be
Commonly Used Incisions for Cardiac Surgery inserted to act as a b tress to keep an artery
• Median Sternotomy is used for operations open. The coronary artery to be stented
of the heart, ascending aorta, and anterior should be at least 3 mm in diameter.
mediastinal structures including the thymus • Transmyocardial Revascularization
and tumors that lie anterior to the heart. (TMR) - performed through a left
• Paramedian Thoracotomy- incision on the thoracotomy incision without the use of CPB.
left side may also be used to biopsy lymph • Cardiac Dysrhythmias
nodes that reside in the aortopulmonary • Maze Procedure- The maze procedure,
window that cannot be reached with a named for the puzzle-like pattern
appearance of the incisions introduced by

D.JUAN
James Cox in 1987, is a cure for AF by • Excessive bleeding can result in cardiogenic
interrupting the impulses that cause the shock and alteration of the body’s clotting
dysrhythmias and preserves the contractility mechanism
of the atria. • Postoperative myocardial infarctions (MIs)
• Radiofrequency Ablation- This treatment are infrequent; however, an MI can lead to
of AF involves the use of a surgical probe cardiogenic shock
that creates a series of linear lesions. • Organ failure is always a concern with
• Cryoablation- This procedure is used to cardiac surgery and CPB. Organ failure can
treat the same dysrhythmias as affect any organ system, but is most
radiofrequency ablation but uses a commonly seen in the kidneys.
refrigerant to freeze the affected area to – • Acute tubular necrosis (ATN) can result from
112° F (–80° C) atherosclerosis of the renal arterial system,
• Mechanical Assist Devices leading to kidney failure
• Cardiac Pacemaker- A pacemaker consists • Adult respiratory distress syndrome (ARDS)
of a pulse generator, which produces and other acute respiratory disorders
electrical impulses, and leads to carry complicate the postoperative outcomes of
impulses to stimulating electrodes placed in some patients undergoing cardiac surgery.
contact with the heart • Wound infections of the sternum can also
• Cardioverter-Defibrillator- The automatic lead to horrific sepsis and are managed
implantable cardioverter-defibrillator (ICD) surgically
has the capability of recognizing potential • Cardiac tamponade occurs when blood and
life-threatening episodes of ventricular fluids build up around the heart
tachycardia or fibrillation • Electrolyte imbalance in magnesium,
• Intraaortic Balloon Pump- is a left potassium, and to a lesser extent, calcium,
ventricular supportive device used to assist a can lead to serious cardiac dysrhythmias
patient with prolonged myocardial ischemia, such as sinus bradycardia, supraventricular
reversible left ventricular failure, or tachycardia (SVT), ventricular tachycardia
cardiogenic shock. (VT), atrial fibrillation, atrial flutter, and
• Ventricular Assist Device (VAD) - to wean ventricular fibrillation (VF)
patients from CPB when the IABP, drugs,
and/or cardiac pacing are ineffective, to VASCULAR SURGERY
support circulation after postinfarction • Vascular Grafts- Biologic or synthetic
cardiogenic shock or traumatic myocardial prosthetic vascular grafts are required to
contusion, and to provide a temporary bridge bypass a vascular obstruction or reconstruct
for support before transplantation vessels. These substitute conduits for blood
• Extracorporeal Membrane Oxygenator- flow vary in length, diameter, and
used as a resuscitative device for patients configuration to meet the requirements of
who have potentially reversible respiratory each situation
and/or cardiac failure. • Percutaneous Transluminal Angioplasty-
• Artificial Heart- Clinical trials are in process PTA is performed under local anesthesia and
to test an artificial heart that can be fluoroscopy, often in the interventional
permanently implanted to maintain radiology department by a radiologist, in the
circulation in the patient with irreparable angiography or cardiac cath laboratory by a
myocardial damage or end-stage cardiac cardiologist, or in the OR by a surgeon.
disease who does not meet the criteria for • Balloon Angioplasty
cardiac transplantation. A total artificial heart • Atherectomy- In an atherectomy, catheter-
also could be used as temporary support mounted instruments are used for
while the patient is awaiting a transplant. transluminal removal of atherosclerotic
plaque
• Thrombectomy and Embolectomy- This
procedure may be performed with
fluoroscopy to selectively cannulate vessels.
Different types and sizes of catheters and
balloons may be used when the blockage is
in a native vessel or an artificial graft
• Thrombolytic Therapy- In thrombolytic
therapy, streptokinase, urokinase, or tissue-
type plasminogen activator (t-PA) may be
COMPLICATIONS: administered by local bolus infusion or x-ray–
• The most common complication of cardiac directed catheter into the occluded vessel or
surgery with or without CBP is stroke. directly injected into the thrombus over a
• Low blood pressure (50-60 mm Hg) during period of 12 to 24 hours.
bypass can lead to ischemic cerebrovascular • Vascular Surgical Procedures
accidents of the brain. Hypertensive • Arterial Bypass
episodes can lead to hemorrhagic brain
insults.

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