Principles Of General Operative Surgery

Question 1

Definition of operative surgery

Answer 1

„(surgical) intervention performed on a living organism on definite medical purpose in professional (surgical) way necessarily causing tissue defect (surgical wound)”

Question 2

Classification of surgeries

Answer 2

According to…
1. Purpose of the surgery: curative, plastic, cosmetic, diagnostic, economic
2. Efficacy of the surgery: radical, palliative
3. Typical/atypical
4. Urgency (CEPOD)
5. Severity (BUPA)
6. Anaesthetic risk (ASA)

Question 3

CEPOD, BUPA, ASA —?

Answer 3

CEPOD: Confidential Enquiry to PeriOperative Death
BUPA: British United Provident Association
ASA: American Society of Anaesthesiology

Question 4

Typical vs atypical surgeries

Answer 4

Typical surgery is one when all steps are known and can be found in protocols, study books etc
Atypical — requires individual approach

Question 5

CEPOD classification of surgeries

Answer 5

Classification according to urgency

1. Elective (e.g. spay, castration)
2. Scheduled (e.g. skin tumour, non-strangulated hernia)
3. Urgent (within 12-24h, e.g. gastric foreign body, bladder stone)
4. Emergency (e.g. GDV, intestinal obstruction)

Question 6

BUPA classification of surgeries

Answer 6

Classification according to severity

1. Minor (e.g. skin tumour, dust removal)
2. Intermediate (e.g. herniorrhaphia)
3. Major (e.g. gastronomy, enterotomy)
4. Major plus (e.g. gastrectomy, colectomy, laparoscopy)
5. Complex major (e.g. thoracic, cardiac surgeries)

Question 7

ASA classification of surgeries

Answer 7

Classification according to anaesthetic risk
1-4

Question 8

Surgical principles of Halsted

Answer 8

1. Handle tissue gently
2. Control haemorrhage!
3. Observe strict aseptic technique
4. Preserve blood supply to tissues
5. Eliminate dead space
6. Appose tissues accurately with minimal tension

Question 9

Surgical asepsis

Answer 9

• operating theatre
• operating site
• instrumentation
• “surgeon’s hand”

Question 10

Methods of sterilisation

Answer 10

• heat
• chemical sterilisation
• plasma sterilisation
• ionising radiation

Question 11

Heat sterilisation

Answer 11

• DRY HEAT
  160˚C - 2h, only metal instruments and gauze sponge/swab, corrosive
• STEAM/AUTOCLAVE
  moist heat, 121˚C - 30 min; 132˚C - 15 min. Variety of instruments, less corrosion

Question 12

Chemical sterilisation

Answer 12

• ethylene oxide
  “Gas sterilisation”, toxic, aeration!
• glutaraldehyde
• formaldehyde (+ autoclave)
• OPA (ortho-phthalaldehyde)

Question 13

Plasma sterilisation

Answer 13

• plasma phase of H2O2 or O2
• free radical reaction
• fast, non-toxic
• expensive

Question 14

Ionising radiation sterilisation

Answer 14

• gamma-beam
• industrial
• suture material, catheters