Essay 15- Basic surgical procedures- resection. Ectomy. Amputation

Resection

• Resection is the medical term for surgically removing part or all of a tissue, structure, or organ’

  • A resection may remove a tissue

  • that is known to be cancerous or diseased

• Depending on the tissue or organ, resection surgery may be an open surgery or may be done with a scope

• through a small incision or a natural entry point

Examples- Resection

• Cholecystectomy (removal/resection of the entire gallbladder)

• Mastectomy of one breast

• Lobectomy of liver or lung

• Sigmoidectomy (removal of the entire sigmoid colon)

• Resection/removal of entire left lobe of the liver

• One or more entire chains of lymph nodes is removed

• Hemicolectomy

• Sigmoid colectomy

• Oophorectomy- can be unilateral or bilateral

• Orchiectomy- can be unilateral or bilateral

Ectomy

• This is a greek term which means cutting out

• It is the surgical removal of something, usually from inside of the body

Examples of ectomy

• Mastectomy- removal of breast (can be unilateral or bilateral)

• Nephrectomy- removal of kidney (can be partial or complete)

• Appendectomy- removal of appendix

• Gastrectomy- removal of stomach (partial or complete)

• Cholecystectomy- removal of gallbladder

• Oophorectomy- removal of ovaries

• Orchiectomy- surgical removal of testes

• Pneumonectomy- surgical removal of lung

• Splenectomy- surgical removal of spleen

• Arthrectomy- surgical removal of joint

• Hemicolectomy- surgical removal of half of the colon

• Vasectomy- surgical occlusion of the vas deferens

Amputations

Amputation is the surgical removal of all or part of a limb or extremity

• such as an arm, leg, foot, hand, toe, or finger.

Indications that amputation may be necessary

• Poor circulation (often due to peripheral arterial disease or diabetes)

• Severe trauma or crush injury

• Infected diabetic gangrene

• Frostbite

• Severe, spreading sepsis

• Devitalised, dead, or necrotic tissues

• Malignant tumors (e.g. osteosarcoma)

• Uncontrolled infections (e.g. osteomyelitis, gas gangrene)

• Painful neuromas (thickening of nerve tissue)

• Congenital limb deformities (less commonly)

Types of amputations

• Non-end bearing (side bearing)

  • the end of the stump is not bearing any weight

  • the sides and the joint above takes the pressure

• End bearing/cone bearing—Weight is taken up by the body.

  • end of the stump supports the body weight

  • feels more natural with a prosthesis

• Provisional amputation with flap—later final formal amputation may be required

  • a temporary amputation

  • skin flap to cover the stump

  • to save life

  • to prevent infection

  • then a proper/ final amputation is done when the patient is stable

• Guillotine amputation- always requires revision formal amputation.

  • very fast straight cut

  • emergency situation

  • used in infections, sepsis, trauma

• Formal amputation—is definitive one

  • planned

  • proper and final surgery

  • stump is carefully shaped

  • closed with skin flaps

  • ready for prosthesis

Ideal stump

• Should heal by 1st intention

• Should have rounded, gentle contour

• with adequate muscle padding

• Should have sufficient length to bear prosthesis

Principles of proper amputations

• Adequate blood supply to the flap should be maintained

• A tourniquet should not be used if amputation is done for vascular diseases

• Flap length should be adequate (heal properly)

• Bone should be cut with a bevel

• all sharp margins should be rounded.

• Postoperatively, regular dressings are done

  • Patient is mobilised using axillary crutches.

• Postoperatively, active exercise should be given to the proximal joint

• so that the prosthesis can be fit to it properly

Complications of haemorrhage

• Early

  • Hemorrhage

  • Hematoma

  • Infection

• Late

  • Hematoma

  • Stump infection

  • Flap necrosis

  • Stump neuroma

  • Stump pain after amputation

  • Ulceration over the stump

Procedure

• May be done with general anesthesia or with spinal anesthesia, which numbs the body from the waist down.

• Surgeon removes all damaged tissue

• leaving as much healthy tissue as possible.

What the Surgeon does before the operation:

• Check for a pulse close to where the surgeon is planning to cut

• Compare skin temperatures of the affected limb with those of a healthy limb

• Look for areas of reddened skin

• Check to see if the skin near the site where the surgeon is planning to cut is still sensitive to touch

During the procedure itself, the surgeon will:

• Remove the diseased tissue and any crushed bone

• Smooth uneven areas of bone

• Seal off blood vessels and nerves

• Cut and shape muscles so that the stump, or end of the limb, will be able to have an artificial limb attached to it