FINAL BST Topics Flashcards
Surgical deontology
The theory or study of moral obligation
Definition: Deontology is the science of professional duties and etiquette.
in this topic you need to talk about what the surgeon MUST do before the operation,
during the operation, and after the operation.
In general, there are two types of deontologists ±
- Absolute deontologists – They believe that some actions are wrong no
matter what consequences follow from them. For example ± by saying “I will
lie”, then their action is wrong, even if some good consequences come out of
it. Greater good is not important (exp. Immanuel Kant) - Non-Absolute deontologists – They think that their actions are right due to
their consequences. In their case for example, lying might be actually the
right thing to do. Greater good is more important
For Exp. Euthanasia or Organ Harvest, the doctor kills one patient to save four others.
This action produces the best consequences, it is not morally wrong, the Non-Absolute
says BUT Absolute will say it’s not moral although it will save more people.
surgical deontology, divided into two parts:
Before the operation- the work of the surgeon starts before the operation where she\he
informs the patient with relevant data risks and benefits concerning his\her operation, and
continuing after the operation when the surgeon gives the right information of “what going
to happen from now.” (treatment, rehabilitation etc.)
the surgeon has to be in good condition both mentally and physically to give the best
treatment.
Mentally- means that the doctor knows the procedures, the operative risks and
complications possible. That he isn’t upset, nervous, etc.;
physically- means that the doctor is in good shape (e.g. his hands doesn’t shake), got
enough sleep, appearance etc.
It is also important to remember that the work of the surgeon doesn’t limited to the
time of the operation and before only, it continues to process of healing with control
examination and administration After the operation part.
Informed consent
In this topic you need to talk about three things ±
A. What is the informed consent
B. What does it contain.
C. Special points.
A. What is the informed consent
The informed consent is a form that supplies the patient with the information
about what going on with him. It should be:
xFully informed.
x Individual & Private.
xConcerning about the state health of the patient.
xBased on the last medical knowledge.
xContinuous and precise.
x In Written form.
When the form is given to the patient, it is important to pay attention to two things ±
xHis age ± in case the patient is too young, the form must be given with the
presence of his legal guardians. E.g. under 18
xMental state ± in case the patient has a mental disability, or other diseases which affect
his memory < ability to think> remember ie Alzheimer, it should not be given to the patient without the appropriate support.
B. What does it contain.
The form should contain the following information ±
xHealth state of the patient.
xWhat the intervention type going to be.
xThe possible complications.
xThe consequences of refusing to the procedure.
x If there is any alternative treatment.
xPost-operative care and lifestyle.
xWritten form
xSIGNTURE OF THE PATIENT!
C. Special points of the form:
The form must be:
xObjective ± the doctor shouldn’t involve feeling while he\she writes the form.
xReal ± it should give the patient the true information as it contains the medical state of him,
and in case of a problem, this form can use as a future document in case of suing
against the hospital\doctor.
xDetailed and Careful ± as doctors, we have to pay attention that we don’t use medical terms,
so it will be simple to the patient to understand his situation.
After the inform consent was given to the patient, has to make his own
decision, and it is under the responsibility of the surgeon to check if the
patient was informed well before the operation takes place.
Cutting instruments
Classification of surgical tool
The surgical instruments are divided into 5 categories -
- Cutting instruments. (Topic 3)
- Hemostatic instruments. (Topic 4)
- Grasping Instruments & Retracting instruments. (Topic 5)
- Special instruments. (Topic 6)
The names of the different instrument can derive from ±
xTheir Function.
xTheir Inventor.
x or sometimes : just because they decide - Cutting instruments
Can be divided into two groups ± Scalpels & Scissors.
Scalpels: (Holding technique Æ Pencil grip or fingertip grip or palm
grip and stretch the skin while making the incision)
x The Cooper (by Astley Cooper), Mayo (by Charles Mayo) & Knee can be in different
sizes and type (blunt/blunt, Blunt/sharp, Sharp/sharp).
x They also can be straight or curved.
Techniques of Holding scissors (same for hemostatic clamps) There are two options ±
x Thumb and Ring finger
x Thumb and middle finger .
Hemostatic instruments
Function ± Stopping of the bleeding.
Characteristic:
xTraumatic- can damage the vessels
xPermanent.
xCrushing.
*Ratchet Lock
We have 6 of them:
4 Hemostatic clamps:
1. Pean (smooth).
2. Kocher (toothed).
3. Lumnitzer (toothed) ± “mega Kocher”.
(remember ± also in grasping, invented by Sandor lumnitzer)
4. Mosquitoes (smallest hemostatic instrument)
And
5. Deschamps ± to go under blood vessels.
6. Diathermy (electro-surgical tools) ± can do both cutting & coagulation function
ic 2017, Dan Perl 8
4. Hemostatic instruments
Function ± Stopping of the bleeding.
Characteristic:
xTraumatic- can damage the vessels
xPermanent.
xCrushing.
*Ratchet Lock
We have 6 of them:
4 Hemostatic clamps:
1. Pean (smooth).
2. Kocher (toothed).
3. Lumnitzer (toothed) ± “mega Kocher”.
(remember ± also in grasping, invented by Sandor lumnitzer)
4. Mosquitoes (smallest hemostatic instrument)
And
5. Deschamps ± to go under blood vessels.
6. Diathermy (electro-surgical tools) ± can do both cutting & coagulation function.
The Kocher was invited by Theodor Kocher (1841-1917), which gave him the
Nobel Prize.
The Pean (by Emile-Jules Pean) & the Kocher can come in varied sizes, where the
biggest Kocher is the Lumnitzer.
They also can be straight or curved.
Grasping and retracting instruments
Grasping Instruments
We can divide it into two groups ±
Forceps & Clamps. Forceps:
(Holding technique = Pencil grip)
1. Anatomical (Smooth).
2. Surgical (Toothed).
3. Special ±
a. Dental.
b. Bayonet-shape.
Clamps:
1. Towel clamps.
2. Backhouse.
3. Doyen.
4. Peritoneal.
5. Lumnitzer (remember ± also in hemostatic).
Retracting instruments
This group is divided into two groups ± Manual retractors & Automatic retractors.
Manual retractors:
1. Langenbeck (1 prong).
2. Rake Retractors (2 ± 8 prongs).
3. Deep surgery retractors.
4. Spatula.
5. Skin Hook.
Both the Langenbeck and the Rake Retractors can have a sharp or blunt tip
Automatic retractors:
1. Finochetto ± Chest retractor.
2. Gosset ± Abdominal retractor.
3. Mastoid retractor.
Special instruments
Vascular clamps:
1. Satinsky.
2. DeBakey.
3. Blalock.
4. Bulldog
Characteristic (of the vascular clamps):
xTemporary.
xAtraumatic. ± dont want to damage the vessel
xNon-crushing.
Also: (the list is long check the internet if you really interested)
1. Intestinal clamps (with or without rubber).
2. Thyroid clamps.
3. Tongue clamps.
4. Dissector.
5. Amputation saw.
6. Trachea canella \ Luer type.
7. Cartilage knifes.
8. Wire saw (Gigli saw)
Suturing instruments
Consist of Needle holder, needles, suturing material and clip instruments.
Needles:
1. Skin ± ¼ or 3/8; Triangular body, sharp tip.
2. Muscle ± ½ or 5/8; Triangular body, sharp tip.
3. Serosal ± ½; Round body, sharp tip.
4. Parenchyma ± Blunt tip.
Needle holders:
1. Mathieu (conventional).
2. Hegar (atraumatic).
3. Zweifel (atraumatic)
Suture material: (more info topics 18-19)
1. Absorbable.
2. Non-absorbable.
Can be monofilament, poly-filament or pseudo-monofilament.
Clip instruments:
1. Clip applying forceps.
2. Clip removing forceps.
3. Michel clips.
Definitions of operation, reoperation, elective, urgent and emergency operation
x Operation: Diagnostic or therapeutic intervention with instruments in order to break or
reconstruct the continuity of different tissues.
x Re-Operation: Repeated operation is needed soon in order to treat complications.
Multiple operations are possible.
Definition of elective, urgent and emergency operation
Elective operation:
xThe best time is elected in respect of the patient’s will.
xAll rules must be kept.
xRisks of the operation are low.
xRelative indication (see nexttopic).
x It can be both with medical importance (i.e. angioplasty ± widening of blood vessels) and
Patient’s will (ie plastic surgery).
Urgent operation:
xHaving the diagnosis, for the safety of the patient, only the most important preparations
must be performed as soon as possible (24-48 hours).
xAbsolute indication (see nexttopic).
x i.e. ± Kidney stones, Stomach ulcer, etc.«
Emergency operation:
xThe aim is to save the life of the patient.
xThe operation must be performed without any delay (fetal end is in direct ratio to the passing time
from the beginning of the problem till the end of the operation!).
xSome operative rules may be disregarded (i.e. history of the patient).
xWe have less information regards the patient.
xVital indication. i.e. accident\ severe injury
Indications and contraindications. Absolute and relative indications
x Indication - the cause\reason of the operation (the illness indicates for the operation).
xContraindication – something that might prevent from the operation to take place (for exp.
a serious heart disease). The problem can be also something else then a disease; it can be also
a state of health or physical condition. For exp.an old patient or an obese patient there might be
some operations where the risk is too high.
xAbsolute indication - if you don’t do the operation, the patient will suffer acute damage to his
health, or even die.
xRelative indication – you have to sum up everything you look at the benefit of the operation,
the risks of it, and the health status of the patient, and after doing that, you have to decide
Tools’ order on the big table
The order (from left to right):
Upper PartRetractors
(mastoid, gosset etc.)
Scalpels
Towel clamps
Doyens
Scissors
Needles & blades box
Saline solution
Swab for skin disinfection
Small & Big dressings
Lower PartSpecial
instruments (bulldog etc.)
Vascular clamps (blalock etc.)
Forceps (anatomical & dental)
Needle holder (Mathieu)
Surgical forceps
Hemostatic clamps (Pean,
Kocher etc.)
Peritoneal clamps
Pick-up forceps
Tools’ order on the Sonnenburg table for venous cutdown technique
this drawing the white-painted instruments are for the skin & muscle incision, this is the “basic”
instruments and by the different colors you can see the additions that you need to make according
to the proper tables.
Tools’ order on the Sonnenburg table for skin and muscle incision, ligation and closure
Muscle Closure – use the muscle needle, Mathieu needle holder, Poly-filament nonabsorbable,
or late-absorbable suture material. The diameter of the suture material usually
will be 1/0 - 3/0 and the stitches will be - simple interrupted stitches. Do the knots on the
middle, and cut the surgery material just above
the knot (= No flags).
Skin Closure – use the skin needle, Mathieu needle holder, Polyfilament non- absorbable
suture material. The diameter of the suture material will be again 1/0 - 3/0, and the stitches
can be simple interrupted or Donati stitches. This time do the knots on the side and cut down
the suturing material 1 cm above the knot (= Flag
Tools’ order on the Sonnenburg table for laparotomy and closure of the abdominal wall
Tools’ order on the Sonnenburg table for tracheostomy
Tools’ order on the Sonnenburg table for vascular surgery
Tools’ order on the Sonnenburg table for intestinal surgery
Surgical needles. Surgical clips, staplers
In general, there are two types of needles ±
xTraumatic ± the suturing material and the needle are not connected (the
ratio between the needle and the material isn’t 1:1,). Cause higher damage
to the tissue.
xAtraumatic ± the suturing material and the needle are connected (the ratio
between the needle and the material is 1:1,). Cause less damage to the
tissue. In this category we also have the double armamentarium, which
has two needles on both sides of the suturing material. (use for vascular
surgery).
The needles have 3 parts ± Shaft\eye, body and a tip
The Shaft\eye:
When we talk about shaft we are dealing with atraumatic needle. In this case the suturing material is continues with the needle itself.
When we talk about eye we are dealing with Traumatic needle (aka conventional
needle). In this case the suturing material doesn’t continue with the needle itself, but
it goes into a hole (=eye) in the end of the needle.
The Body:
The bodies are the middle portion of the needle (Different body shape Æ different use).
Round (serosa).
Triangular (skin\muscles).
Spatula- a minute needle with a flat or slightly curved concave surface that does not cut or
pierce
Lancet.
Diamond.
The Tip:
can be ±
Sharp - to get through the tissue.
Blunt ± to avoid hurting the tissue & friable organ (i.e. liver).
The names come from the shape of the needles ±
Taper ± Round body, and become sharp towards the tip.
Spatula ± use mainly for eye sugary ( ).
Regular cutting ± triangular body, cutting edges on the inside.
Reverse cutting – triangular body, cutting edges on the outside.
Surgical clips. Staplers and their application fields.
In the clips we have 2 instruments (for pictures look at topic 7)
- Clip applying forceps.
- Clip removing forceps.
We use the Michel-clips.
The staples can be ± (it was invited by Petz Aladar - Hungarian)
Straight.
Curved.
Circular (use in End-to-End anastomosis).
Type of clips:
1.For ligation ±
a. Absorbable:
i. Lactomer 9-1.
ii. Polydioxanone.
b. Non-Absorbable:
i. Stainless steel.
ii. Titanium.
2.For surgical staplers ±
a. Surgical staplers.
b. Polysorb stapler.
c. Poly surgiclip.
Use:
xClosure of wounds (internal\skin).
xConnects pars of lung\intestine.
xThe best wound healing effect
Side effects:
x May interfere with MRI.
Absorbable suture materials (definitions, classification, fiber characteristics)
surgical suture materials can be - natural or synthetic materials.
They keep wound edges together during the early wound healing.
The wound healing depends on the regenerative capacity of the organism.
Absorbable:
A. Natural
1. Cat gut (animal origin).
2. Collagen (animal origin)
B. Synthetic
1. Polyglycolic acid.
2. Polyglactin 910.
3. Polydiaxanone.
4. Polyglyconate.
5. Lactomer 9-1.
6. Glycomer 631.
7. Glyconate.
8. Polyglecaprone 25.
9. Polyglytone 6211.
10. L-lactid\glycolid.
Advantages:
x It dissociates \ absorbed by ± hydrolysis or by proteolytic enzymes.
x Time: 10 days to 8 weeks
x It uses for internal organs and peritoneum.
x Complications ± can cause inflammation.
Non-Absorbable:
A. Natural
1. Silk (animal origin).
2. Linen (plant origin).
3. Steel (mineral origin).
B. Synthetic
1. Polyamide.
2. Polyester.
3. Polypropylene.
4. Polytetrafluoroethylen.
5. Polybuteser.
Advantages:
x Used in places with constant pressure like heart\bladder, and in the skin\vascular
surgery.
x Cause to a lesser immune response, which means less scaring.
The advantage of synthetic over natural is that the synthetic contains more disinfectant.
Fiber Characteristics:
It can be -
Monofilament. ± no drainage, capillary or serrating (cutting the vessels) effect.
Poly-filament:
o Twisted.
o Braided.
Pseudo-Monofilament (It has a poly-filament with a “coat”).
Advantage of the Pseudo-Monofilament\Monofilament over the Polyfilament
material is that they don’t have
“drainage effect” ± when liquid drain from one side to the other, along
the material and increase the risk to inflammation.
It comes in varied sizes:
xMetric size (use in Europe) ± from 0.1 (0.01 - 0.019 mm) to 10 metric (1 - 1.09 mm)
xUSP\British size (use in USA) - from 11/0 size (0.010-0.019 mm) to 6 size (1.00-1.09 mm).
Threads size ±
skin, muscle 2/0, 0
gastro-intestinal 3/0, 4/0
5/0 - large vessels, 6/0 7/0 large veins
9/0 10/0 11/0 - micro-surgical
The material is kept in a package with the following information:
Brand.
Type.
Color.
Material.
Width.
Length.
Sterilization mode (EO=Ethylene Oxide, Y=gamma).
Date.
Code #.
Non-absorbable suture materials (definitions, classification, fiber characteristics)
Non-Absorbable:
A. Natural
1. Silk (animal origin).
2. Linen (plant origin).
3. Steel (mineral origin).
B. Synthetic
1. Polyamide.
2. Polyester.
3. Polypropylene.
4. Polytetrafluoroethylen.
5. Polybuteser.
Advantages:
x Used in places with constant pressure like heart\bladder, and in the skin\vascular
surgery.
x Cause to a lesser immune response, which means less scaring.
The advantage of synthetic over natural is that the synthetic contains more disinfectant.
Fiber Characteristics:
It can be -
Monofilament. ± no drainage, capillary or serrating (cutting the vessels) effect.
Poly-filament:
o Twisted.
o Braided.
Pseudo-Monofilament (It has a poly-filament with a “coat”).
Advantage of the Pseudo-Monofilament\Monofilament over the Polyfilament
material is that they don’t have
“drainage effect” ± when liquid drain from one side to the other, along
the material and increase the risk to inflammation.
It comes in varied sizes:
xMetric size (use in Europe) ± from 0.1 (0.01 - 0.019 mm) to 10 metric (1 - 1.09 mm)
xUSP\British size (use in USA) - from 11/0 size (0.010-0.019 mm) to 6 size (1.00-1.09 mm).
Threads size ±
skin, muscle 2/0, 0
gastro-intestinal 3/0, 4/0
5/0 - large vessels, 6/0 7/0 large veins
9/0 10/0 11/0 - micro-surgical
The material is kept in a package with the following information:
Brand.
Type.
Color.
Material.
Width.
Length.
Sterilization mode (EO=Ethylene Oxide, Y=gamma).
Date.
Code #
Properties of the ideal suture material. Reaction index
When we are talking about the “ideal suture material” we need to look at it from 3 aspects ±
Physical point:
x High tensile strength.
x High breaking strength.
x Good tying capability.
x Good knotting holding security.
x High flexibility.
x Monofilament.
x Surface smoothness.
x No cutting or serrating effect.
x Easy to sterilize.
Biological point:
x Doesn’t cause edema.
x Doesn’t cause allergic reaction.
x Not Toxic.
x Doesn’t have carcinogenic effect.
x Minimal drainage effect.
x Minimal tissue reaction (R1 ~1).
x Minimal tissue effect.
x Minimal adhesion effect.
Chemical point:
Resistance to:
x Acids.
x Alkalis.
x Bacteria.
x Enzymes.
Reaction index:
The reaction index is the ratio of the suture material and reaction area (the area
which shows any reaction to the suture material).
The lower the value of this ration, the higher the reaction = higher inflammation.
Suturing and knotting techniques. Technique of suture removal
While reading this topic, I suggest go to p.35 or “surgical techniques” to see pictures.
Knotting techniques:
A. Mariner knot ± each time one loop (=square knot).
B. Surgical knot ± first time two loops second time one loop (=surgeon’s knot).
The advantages of Surgical knot over Mariner is it has more friction and it is more secure.
Suture techniques:
A. Interrupted sutures ±
1) Simple.
2) “Mattress” ±
a. Vertical (Donati).
b. Horizontal.
3) Parenchymal ±
a. U.
b. X.
c. Z.
d. 8.
Advantages:
It uses to close wounds.
it easy to put another one instead of the one who damages\ruin.
B. Continuous suture ±
1) Simple.
2) Special (locked).
Advantages (of the continuous over simple):
Quicker for doing.
Less material has to be used.
Less places for the infection to arbor.
Disadvantages:
Can cause more damage.
If fail, all the suture has to be replace.
More painful to remove.
General properties:
x Start suture from left to right.
x Suture towards you.
Suture removal technique:
First, you have to swab the wound and remove the exudates. Then grasp the knot
and gently elevate it. Lastly, cut the suture with scissors where it enters the skin.
use anatomical forceps and sharp-blunt scissors,
simple interrupted ± cut under the knot. The idea is less suture material that will pass
through the body thus leads to less infection (what was outside stays out).
*If you use anatomical forceps then hold the suture material but if you use surgical
then hold the knot itself.)
Asepsis and antisepsis.
Aim: Preventing contact with microorganisms and make the surgery procedure with the
safest that it can be.
We create Asepsis & Antisepsis environment
Asepsis - the prevention of contact with microorganisms by the creation of sterile conditions
(clothing, instruments, isolation towels)
Antisepsis - the prevention of infection by inhibition of infective agents (scrubbing, disinfection
of operative field).
*together they help each other and provide success in modern surgery.
People worth mentioning (know 1 or 2):
Ignac Semmelweis (Hungarian) (1818-1865) ± in 1847 invented hands wash
with chloride of lime.
William Stewart Halsted (1852-1922) ± in 1886 invented the surgical gloves.
Joseph Lister (1867)- hand wash with soap and carbolic acid.
Furbringer (1888)- hand wash with soap and sublimate
Ahlfeld (1896)- hand wash with soap and alcohol
Types and requirements of disinfectants and scrub solutions
Disinfectants ± used for sterilizing objects and places that can’t be sterilized by normal methods.
by destruction or inhibition of reproduction of live infective agents.
Disinfectants requirements:
x Wide range of effectiveness
x Short reaction time 5-10 min
x Good solubility and penetration
x Do not damage surface and do not discolor
x Stable and dont have unpleasant smell.
Scrub solutions requirements:
x They have to form a film on the skin.
x They mustnt reduce the effect of blood and other tissue fluids.
x They musnt dry the skin
x they mustnt cause any allergy.
Effects for scrub solution & disinfectants:
x Bactericidal ± kill bacteria. (i.e. tuberculoid)
x Virucidal ± kill viruses (I.e. HBV, HIV)
x Fungicidal ± kill fungi.
x Sporocidal ± kill\destroys spores.
Scrub solutions:
x Skinman soft N.
x Skinman asept.
x Biotensid.
x Sterillium.
Disinfectants solutions:
x Isopropyl- alcohol
x Ethyl-alcohol
x Hydrogen peroxide
Behavioural rules in the operating theatre.Scrubbing. Gowning and gloving
Staff in operating theatre:
Surgeons, anesthesiologists, instrumental\circulating nurses, labor assistants, technical stuff
and visitors
From the moment that you are in the operation theater you expect to behave as following:
x When you dont use your hands, they should be up in the air (Above the level of the table)
x dont touch anything that is sterile.
x Dont rub any part of body.
x dont run in the operating room.
x Don’t turn your back to the table.
*These rules are important to all the people who are in the room ± starting from
the surgeon and ends in the observer (i.e. student).
Scrubbing, Gowning and gloving
These are the procedures that we are doing before entering the operation theater.
The purpose of them is to clean our hands, and to cover our body with isolated clothes.
change the clothes and shoes with clean
ones (can also be disposable clothes).
This include (asepsis action):
1. scrub suite ± shirt & trousers.
2. theatre shoes\slippers & socks
(the shoe cover).
3. surgical cap.
4. surgical face mask (or protective
glasses).
A. Scrubbing (antisepsis action): the
process of removing all the pathogenic
agents (microorganisms) from the skin surface of our hands.
(Transient flora ± completely, Resident flora - partially).
Also, it
reduces the number of the bacterial count in the deep pores and fixing them.
The technique of scrubbing:
a. Before entering the scrubbing room, take off the jewelry and cut your nails (artificial
fingernails) also nail-polish isn’t allowed.
b. Wash your hands and forearms with soap and warm ruining water for 1-2 min.
c. Rinse from the hands downward toward the elbow.
d. Rub the antiseptic scrub solution (5 ml) on hands and forearms for about 1 min.
e. Repeat section d for 5 times, when every time you are rubbing a little less
(first time till the elbow and in the 5th time only rub your hand).
Total length of the scrub is minimum 5 min.
Hands need to be dry in the end of the scrubbing!
B. Gowning:
The gowns are kept in schimmelbusch box. On the gowns there is an indicator tape which changes its color from yellow to brown.
(Brown means it’s ready!).
Disinfection and isolation of the operative field and skin
Disinfections are the products which help to disinfect the operating field removing of all
the pathogenic microbes.
At the beginning of the operation, we need to disinfect the skin and isolate it.
Skin disinfection:
This process been done in the operative field by the usage of scrubbing of the
skin with disinfectants like
Betadine.
Dodesept.
Kodan.
Cutasept.
Technique of disinfection:
There are two techniques, where in both you start from the center and work outwards:
xConcentric circles.
xStripes on both sides
Repeat for minimum of two times.
It is important to remember ± NEVER clean same place twice with same pad.
Surgical hemostasis – stop the bleeding temporary
Surgical hemostasis – stop the bleeding definitively
Principles of electrosurgery
Injection techniques in general (tools, steps). Intracutaneous, subcutaneous, intramuscular and
intravenous injections
Technique of blood sampling (tools, steps, Vacutainer tubes)
Infusion solutions. Technique of infusion (tools, steps)
Instrumentation and steps of venous cutdown technique. Preparation of the venous catheter
Catheterization in general. Catheter types. Urinary bladder catheterization
Classification of laparotomies (direction, relation to muscles)
Median laparotomy (anatomy, operative technique)
Paramedian laparotomy (anatomy, operative technique)
Abdominal wound closure in three layers (explaining surgical anatomy)
Wound types and characterization. Phases of wound healing
Basic principles of wound treatment. Wound dressings
Drains in general. Puncture of the abdominal and thoracic cavity
Causes and mechanisms of upper airway obstruction
Priorities in the management of upper airway obstruction. Conicotomy (indication, surgical
anatomy, operative technique)
Tracheostomy (indication, surgical anatomy, operative technique)
Early and late complications of tracheostomy
Basic principles of intestinal surgery. Conventional suturing techniques and staplers
Adhesion problem in abdominal surgery (definition, causes, pathomechanism, classification,
rules and possibilities for prevention)
Basic principles of liver surgery (surgical anatomy, terminology for liver resection, operative
techniques).
Basic principles of spleen surgery (surgical anatomy, operative techniques, possibilities of
organ saving surgery).
Transplantation possibilities of the abdominal parenchymal organs
Bioplasts – definition, types, application field
Surgical tissue adhesives – definition, types, application field
Basic principles of vascular surgery (arteries)
Basic surgical principles of venous and lymphatic surgery
Minimal invasive surgery: laparoscopy, microsurgery
Differences between laparotomy and laparoscopic interventions
x Cholecystectomy is (removal of the gallbladder).
x Diagnostic purposes.
Famous surgeons in the history of surgery (instruments, tools, operative techniques)
