Principles of Operative Techniques

Question 1

What does the H stand for in Halsted’s principles?

Answer 1

Haemostasis

Question 2

What does the A stand for in Halsted’s principles?

Answer 2

Aseptic Technique

Question 3

What does the L stand for in Halsted’s principles?

Answer 3

Light touch (atraumatic)

Question 4

What does the S stand for in Halsted’s principles?

Answer 4

Supply of blood preserved

Question 5

What does the T stand for in Halsted’s principles?

Answer 5

Tension-free closure

Question 6

What does the E stand for in Halsted’s principles?

Answer 6

Even tissue apposition

Question 7

What does the D stand for in Halsted’s principles?

Answer 7

Dead space obliterated

Question 8

What are the four basic steps in surgery?

Answer 8

Incision & excision of tissues, Haemostasis, handling and care of tissues, closing with sutures (and other materials)

Question 9

What instruments/methods can be used to incise/excise tissues? What is their uses?

Answer 9

Scalpel (tough tissue, tissue under tension), Scissors (cutting tissue below skin, blunt dissection), Electrosurgery & lasers (vaporise tissue along incision)

Question 10

What are Mayo scissors? What are Metzenbaum scissors? What are they used for?

Answer 10

Mayo - Heavy scissors, used for dense collagen rich tissue.

Metzenbaum - fine scissors, used for blunt dissection and sharp dissection of delicate tissues.

Question 11

In electrosurgery (diathermy), how will using a continuous undamped sine wave affect the incision? How about an interrupted damped sine wave?

Answer 11

Continuous undamped = increased cutting, minimum coagulation.
Interrupted damped = increased coagulation, decreased cutting.

Question 12

What are the 4 principles in preventive haemostasis?

Answer 12

1) Plan the approach, 2) Identify BV in the surgical field, 3) Ligate BV before transection, 4) Gentle dissection.

Question 13

For a vascular pedicle, what is the best ligature technique to achieve haemostasis?

Answer 13

Three clamo technique, transfixing ligatures, dividing the pedicles.

Question 14

What is monopolar electrosurgery?

Answer 14

Current flows between handpiece and ground plate. Increased ability to cut as well as coagulation.

Question 15

What is bipolar electrosurgery?

Answer 15

Current between two tips of bipolar forceps. Decreased tissue trauma, burns unlikely, can be used in a wet surgical field.

Question 16

What are haemostatic forceps used for? Can you name any?

Answer 16

Crush the tissue or vessel at point of contact. Halstead mosquitos, kelly, carmalt, kocher.

Question 17

What types of instruments/techniques are good to handle tissues atraumatically?

Answer 17

Stay sutures, thumb forceps, tissue forceps etc.