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Basic Surgical Techniques E-Book

Basic Surgical Techniques E-Book

R. M. Kirk

(2010)

Additional Information

Book Details

Abstract

The Sixth Edition of this highly regarded title for surgical trainees gives clear, concise guidance on all aspects of acquiring surgical skills to ensure operative success. The full range of surgical procedures is comprehensively reviewed in a clear ‘how-to-do-it’ style, which consolidates the skills learnt both in theatre and on training courses. This new edition has been completely updated throughout, with all the illustrations redrawn in full colour. Each chapter is introduced with a key points box, which briefly summarises the major issues that are covered. International experts from the Middle East, Australia, Asia, North America and Europe have reviewed and added their comments to the text.

    • Provides guidance on the full range of surgical techniques required by all trainee surgeons.
    • Concentrates on the main principles behind the use of the surgical techniques
    • "Key Points" boxes throughout provide hints and tips to reinforce the main aspects of each technique.
  • Now presented in full colour with all illustrations redrawn to add detail and clarity and to bring all the information fully up to date.
  • A comprehensively updated text takes account of new developments in surgical techniques and equipment.
  • A new final chapter on surgical craftsmanship brings the skills all together for the surgeon in the operating theatre, uniting and applying the relevant factors in the correct sequence and focussing on getting it right first time.

Table of Contents

Section Title Page Action Price
Copyright iv
Preface v
Acknowledgements vii
Handling yourself 1
Attitudes – the five ‘cs’ 2
Physical Attributes 2
Hands 2
Stability 2
What Is Skill? 3
Exercises Versus Practice 4
Haptics 4
Transferable Skills 5
Speed 5
Sequence (L sequi = to follow) 6
Skills Courses 6
Rational Assessment Of Information 6
References 7
Further reading 7
Handling threads 9
Thread Characteristics 21
Sizes 22
Knots 22
Two-handed knot 25
One-handed knot tied with the left hand 27
Knot tied using instruments 31
Laying and tightening knots 31
Tightening under tension 34
Tying knots in cavities 35
Ligatures 36
Stitches 38
Needles 38
Stitching with a curved needle 41
Types of stitch (Fig.3.66) 42
Interrupted stitches 43
Continuous stitches 44
Handling ducts and cavities 47
Intubation 48
Percutaneous intubation 48
Direct intubation 51
Fixing catheters and tubes 54
Dilating Ducts 56
Bougies 56
Balloons 58
Other methods 58
Endoscopic Access 58
Rigid instruments 60
Flexible endoscopes 62
Display 63
Occlusion 63
Divided duct 63
In continuity 64
Control of leakage 64
Disobliteration 65
Repair 68
Gastrointestinal tract 70
Other ducts and cavities 70
Resection 71
Anastomosis 71
Principles 71
Bowel 71
Alternative methods 73
Mobile bowel, edge to edge, single layer, interrupted stitches 73
Edge to edge, single layer, continuous stitches 73
Fixed bowel, single layer, interrupted stitches 74
Two-layer anastomosis 75
Variations 75
Other ducts 75
Bowel Transfer 76
Sphincters 77
Myotomy 77
Sphincterotomy 78
Sphincteroplasty 79
Sphincter repair 79
Sphincter reversal 79
Acquired Channels And Cavities 79
Sinus 79
Fistula 80
Stoma 81
Cysts 81
Abscesses 81
Handling blood vessels 83
Percutaneous Puncture 84
Veins 84
Arteries 86
Percutaneous Cannulation 87
Veins 87
Arteries 87
Percutaneous Catheterization 88
Seldinger technique 88
Endovascular Surgery 89
Sutures 90
Expose and Control (see also Ch. 10.) 92
Incision 93
Veins – Direct Procedures 93
Varicose veins 94
Arterial replacement with vein 95
Arteries – Direct Procedures 96
Incision and closure 96
Direct catheterization 96
Embolectomy 96
Vein patch 96
Arterial Anastomosis 97
End-to-end anastomosis 97
End-to-side anastomosis 99
Microvascular Surgery 99
Basic technique 100
Reference 102
Handling skin 103
Structure 103
Healing 104
Open wounds 104
Wound Management 105
Wound closure 106
Analgesia 106
Incision 106
Excision 108
Skin lesions 108
Intradermal or subcutaneous cyst 108
Closure 109
Simple linear 109
Subcuticular stitch 110
Closing defects 112
Grafts 113
Split-skin graft 114
Full-thickness graft 116
Flaps 116
Z-plasty 116
Transposition flaps 117
Myocutaneous and compound flaps 117
Free Tissue Transfer 118
Tissue Expansion 118
Aesthetic Procedures 118
Liposuction 118
Lipoplasty 118
Clostridium botulinum 118
Breast procedures 118
References 118
Handling connective and soft tissues 119
Percutaneous Diagnostic Procedures 120
Aspiration of fluid for cytology 120
Needle biopsy 120
Open biopsy 121
Connective Tissue 122
Areolar tissue 122
Aponeuroses 122
Tendons 123
Ligaments 124
Nerves 124
Skeletal Muscle 125
Cartilage 125
Mucoperiosteum 126
Breast 126
Lymph Nodes 126
Sentinel node biopsy 127
Abdominal Wall 127
Midline abdominal incision 127
Gridiron incision 129
Hernia 129
Abdominal Contents 130
Bowel 130
Liver 130
Spleen 130
Pancreas 131
Urological System 131
Kidney 131
Ureter 131
Bladder 131
Testis 131
Penis 131
Gynaecological System 131
Uterus 131
Ovaries 132
Cardiorespiratory System 132
Lung 132
Heart 132
Endocrine System 132
Brain And Spinal Cord 132
Handling bone and joints 133
Bone 133
Physical Characteristics 133
Exposure 134
Steadying 134
Biopsy 134
Cutting 135
Hand saw 135
Gigli saw 135
Powered saws 135
Osteotome 136
Chisel 136
Cutting forceps 137
Rongeurs 138
File 138
Drilling 138
Fixing 139
Screws 139
Stitching 141
Wiring 142
Plates 142
External fixators 144
Intramedullary fixation 144
Bone grafts 146
Amputation 146
Joints 147
Cartilage 148
Ligaments 148
Tendon Insertion 148
Handling dissection 149
Organize 149
Expose 150
Dissection Methods 151
Sharp 151
Blunt 152
Instrumental 154
Layered or Solid Tissues? 154
Tissue Planes 155
Solid Tissues 157
Imaging 157
Dissecting 157
Diseased Tissues 158
Neoplasms 159
Aids to Dissection 159
Anatomy 159
Palpation 160
Haemostasis 160
Find a safe starting point 160
Tension 160
Dissecting around structures 161
Needles 162
Fluid infiltration 162
Transillumination 162
Probes and catheters 162
Dyes 162
Marker stitch 163
Intraoperative ultrasound scanning 163
Flexibility 163
Priorities 163
Reference 163
Handling bleeding 165
Haemorrhage 165
Prevention 165
Aids 166
Elevation 166
Fluid infiltration 167
Transillumination 167
Tourniquet 167
Technical aids (see also Ch. 2) 167
Control 168
Intracavity bleeding 169
Intracranial Bleeding 170
Handling drains 171
Caution 171
Types 172
Packs and wicks 172
Sheet drains 172
Tube drains 173
Sites 174
Subcutaneous 174
Subfascial and intramuscular 175
Extraperitoneal 175
Intraperitoneal 175
Pleural cavity 176
Abscesses and Cysts 177
External Fistulas 177
Negative Pressure Wound Healing 177
Reference 178
Handling infection 179
Principles 179
Infections 180
Cellulitis 180
Abscess 180
Sirs and Sepsis 180
Viral Transmission 180
Universal Precautions 180
Trauma 181
Preoperative 181
Operating Routines 181
Operation 182
Bleeding 182
Surgical Site Infection 182
Treating Infections 183
Cellulitis 183
Abscess 183
References 184
Handling minimal access surgery 185
Examples 185
Laparoscopy 186
Access 186
Closed pneumoperitoneum 186
Open pneumoperitoneum 187
Technical Aspects 188
Closure 189
Acquiring Skills 189
Other procedures 193
References 193
Handling craft skills 195
Physician/Surgeon 195
Skills Courses 196
Operating Precepts 197
Gentleness 197
‘Setting up’ 197
Speed 197
Sequence 198
Strategy/tactics 198
Tissue oxygenation 198
Emergencies 198
Error Avoidance 198
Assisting at Operations 199
Mentoring 200
Ten reminders 200
Common Sense 200
References 201
Index 203