POUL 3000 Surgical Tools and Techniques

what is inpatient surgery

hospital admission and overnight stay

what is outpatient surgery

no hospital admission or overnight stay

what does inpatient surgery involve

• invasive procedures performed in operating room

• high-risk due to patient health status

what classifies as an invasive procedeure

body cavity is entered and mesenchymal barrier is breached

organs removed or normal anatomy is altered

what are the different membranes that can be entered

• pleural membrane -lungs

• peritoneal membrane - abdomen

• meninges - brain/spinal cord

where is the pleural membrane located

thoracic cavity

where is the peritoneal membrane located

abdominal cavity

what is involved with outpatient surgery

minimally invasive procedures

what is classified as a minimally invasive procedure

only skin, mucus membranes, or connective tissue breached/resected

what are examples of minimally invasive procedures

vascular catheter placement

ocular and ear/nose/throat procedures

procedures involving extremeties

what is an ectomy

procedures involving excision

hysterectomy

uterus

tonsillectomy

tonsils

splenectomy

spleen

cholecystectomy

gall bladder

what is an otomy

procedures involving cutting into organ or tissue

laparotomy

abdominal cavity

lobotomy

brain

craniotomy

cranial cavity

myotomy

muscle

what is an ostomy

procedures involving formation of opening

colostomy

colon

tracheostomy

trachea

plasty

procedures involving modifications or reshaping

rhinoplasty

nose

oculoplasty

eye

otoplasty

ear

myoplasty

muscle

oscopy

procedures involving endoscope insertion

what is open surgery

traditional surgery with larger incision for visualization and instrument insertion

when is open surgery used

when minimally invasive techniques cannot be used

• need more visualization for diagnosis or procedure

  • need larger access area for materials or instruments

what is open surgery not used more

exploratory purposes

what is endoscopic surgery

minimally invasive surgery (MIS) that uses a scope and surgical tools through small incisions or natural body openings

what kind of surgery does endoscopic surgery tend to be

outpatient w

what is endoscopic surgery used for

exploratory and treatment purposes

what are pros of endoscopic surgery

smaller incision and reduced cons

what is reduced with endoscopic surgery

blood loss, body cavity invasion, risk of infection, antibiotic use, scarring

what is good about a smaller incision

• smaller wound

• less pain

• less prescription pain medication

• shorter recovery time

what is endoscopic surgery performed through

natural openingswha

what are the natural openings that endoscopic surgery can be performed through

GI tract, respiratory tract, otoscopy, urogenital tract

what is an example of GI tract endoscopic surgery

colonoscopy

what is an example of respiratory tract endoscopic surgery

rhinoscopy

what is an example of urogenital tract surgery

cytoscopy

what kinds of surgeries are performed through small incisions

laparoscopy - abdominal or pelvic cavity

arthroscopy - joints

thoracoscopy - chest cavity

what are endoscopic surgery tools

endoscope - flexible tube with attached fiber optic camera and light

small surgical instrument - forceps, suction devices, surgical scissors, balloons

what are 6 advantages of endoscopic surgery

• reduced pain/pain medication

• reduced blood loss

• reduced risk of infection

• lower antibiotic usage

• shorter recovery time

• reduced scarring

what are cutting and dissecting tools used for

cut through tissue and suture material

used for incision, sharp dissection, or excision of tissue

what are 4 cutting and dissecting tools

• scalpel

• surgical scissors

• surgical saw

• bone cutters

what are clamping and occluding tools used for

• restrict tissue

• used to compress blood vessels or hollow organs and prevent leakage

• ratchet or spring-loaded; serrated jaws, straight or curved

what are 3 clamping and occluding tools

• hemostatic forceps

• mosquito forceps

• bulldog clamps

what are retracting and exposing tools used for

• increase access to surgical site

• used to hold back tissue and organs and separate edges of surgical incision

• manual (hand-held) or self-retaining (stay open on their own)

what are 4 retracting and exposing tools

• manual retractors

• self-retaining retractors

  • weitlaner

  • lone star

what are grasping and holding tools used for

• used to manipulate and hold tissue, surgical drapes and sponges, and suturing material

• help maintain aseptic technique

what are 4 types of grasping and holding tools

• tissue forceps

• allis clamp

• sponge forceps

• needle drivers

what is electrosurgery

application of high-frequency, alternating electrical current of various voltage to denature, desiccate, and cut

denaturation electrosurgery

proteins unfold

desiccate electrosurgery

dries out tissue

cut electrosurgery

causes small area of tissue to be vaporized, resulting in an incision

what two settings are used for coagulation for electrosurgery

seals small vessels to stop bleeding

fulgurate electrosurgery

destroys tissue through creation of electric arc through air (electrode does not directly contact tissue)

what happens to tissue at approximately 60ºC

necrosis

what happens to tissue at approximately 70ºC

protein denaturation, which contributes to coagulation

what happens to tissue at approximately 100ºC

water vaporizes, allowing tissue cutting

what temperature is associated with fulgaration

approximately 200ºC

what settings are associated with cutting mode

lower voltage, higher frequency, and higher duty cycle

what settings are associated with coagulation mode

higher voltage, lower frequency, and lower duty cycle

what happens to tissue during electrosurgical cutting

tissue water rapidly vaporizes, allowing the tissue to separate

which electrosurgical mode is associated with vaporization

cutting mode

what electrosurgical mode is associated with protein denaturation

coagulation mode

what is the main difference between CUT and COAG

CUT vaporizes water to separate tissue, COAG heats tissue to denature proteins and control bleeding

what kind of waveform does cut use

continuous and uninterrupted delivery

what kind of waveform does coag use

pulsed delivery

what kind of waveform dose blend use

mixture of cut and coag properties

what are bipolar electrosurgical units

active and return electrode functions performed at surgical site

only tissue grasped inside forceps is included in electrical circuit and will be affected

what are 3 pros of bipolar electrosurgical units

• allows for coagulation in “wet” (bloody) fields

• lower voltage = less collateral tissue damage

• no risk of patient burns at return electrode

what are 2 cons of bipolar electrosurgical units

• limited ability to small areas

• lower voltage = lower power so coagulation could take longer

what are monopolar electrosurgical units

active electrode is placed at surgical site and patient return electrode (aka dispersive pad) is placed elsewhere on body

current passes through patient as it completes circuit

dispersive pad safely removes current from patient’s body

what are 2 pros of monopolar electrosurgical units

• more versatile

• use in larger surgical fields

what are 3 cons of electrosurgical units

• more collateral tissue damage

• may lead to patient burns

• must be careful of metal implants

what kind of electrosurgical unit do we use

monopolar

what kind of collateral damage does the CUT setting have

least

what kind of collateral damage does the COAG setting have

most

what kind of collateral damage does the BLEND setting have

intermediate

what kind of temp dose the CUT setting have

hottest

what kind of temp dose the COAG setting have

hot

what kind of temp dose the BLEND setting have

hotter

what are the 4 perioperative phases of surgery

1. preoperative care

2. staging

3. surgical procedure

4. postoperative care

what are 5 parts of preoperative care

1. medical exam to assess fitness for surgery

2. risks discussed and medical consent obtained

3. autologous blood donation

4. bowel preparation for GI tract surgeries

5. no food or drink

what is involved in the medical exam to assess fitness for surgery

CBC, prothrombin time, partial thromboplastin time, comprehensive metabolic panel

what is autologous blood donation used for and when is it done

if significant blood loss is expected

several weeks before surgery

how long should the surgical team scrub for

scrubbed for at least 4-5 minutes

what is a normal chicken body temperature

103-108

what is a normal chicken heart rate

245 (220-300)

what is a normal chicken blood pressure

15-40/8-30

what is a normal chicken respiratory rate

12-36

what are the 5 steps of staging

1. vital signs recorded

2. peripheral IV lines places

3. preoperative medications administered

4. administration of anesthesia

5. preparation of surgical site

what are the 4 steps of the surgical procedure

1. surgical incision made to access surgical target

2. monitoring of vital signs, heart rhythm, and blood oxygen

3. isolation and procedure on surgical target

4. suturing

what are three steps of postoperative care

1. transfer to post anesthesia care unit for recovery from anesthesia

2. pain management and wound care

3. information regarding potential side effects or complications

what do you check when you transfer to post anesthesia care unit

close monitoring of vitals, heart rhythm, blood oxygen

assessment of general function

check for signs of allergic reaction

what happens for discharge with outpatient surgery

discharged after demonstrating ability to breath normally, drink, and urinate