BASIC SURGICAL
TECHNIQUES
G. Weber M.D., Ph.D
Professor of Surgery
Department of Surgical Research and Techniques
Medical Faculty, Semmelweis University
BASIC SURGICAL TECHNIQUES
Basic surgical skills are needed throughout the medical profession
Our aim
to teach and practice basic surgical maneuvers
Topics:




special behavior in the operating theatre,
preparation the surgical team before operation,
surgical tools and instruments,
wound management.
skills training and assessment
Skills training
Skills training allows
 to appreciate your own technical ability,
 reveal whether you are interested in
participating in technical procedures, and
 therefore influence your choice of residency
training.
Skills training and assessment
Surgeon
OR
Researcher
Key competencies required for a physician
Technical skills
&
Intellectual skills
Coordinated team work
Intellectual skills
(non-technical skills)
manifested in aspects of performance, such as
 leadership,
 decision-making,
 task management,
 communication and
team working,
 situational awareness.
Recognize: collapse, Decision: help (in time!)
DEPARTMENT OF SURGICAL
RESEARCH AND TECHNIQUES
 Dpt. and secretary: NET XI. floor
 English course director:
Györgyi Szabó e-mail: gyorgyisami@yahoo.com
 feedback: mutettan@gmail.com
 Homepage: http://semmelweis.hu/mutettan
 Informations and abstracts of the lectures here
following the presentations.
Lectures:
Date
(Monday 15.00-15.45)
Subject
Lecturer
February 3
Presentation of Dept and the curriculum. The operating room.
Prof. Dr. György
Wéber
February 10
Asepsis, antisepsis, and desinfection. The surgeon in the
Operating Room and the prevention of Surgical Site Infection.
Prof. Dr. József
Sándor
February 17
Basic surgical tools and suture materials
Dr. Andrea Ferencz
February 24
Basic and special suturing techniques in surgery
Prof. Dr. István Gál
Classification and managements of wounds, principle of woundhealing, haemorrhage and bleeding control
Györgyi Szabó
March 10
Surgical procedures involving:acute, elective, preoperative
patient management , and surgical explorations.
Prof. Dr. György
Wéber
March 17
Basics of laparoscopic surgery
Prof. Dr. György
Wéber
Marc 3
Practical sessions
Every group has 7 practicals – week ‘A’ and week ‘B’
Monday
Tuesday
Wednesday
11.20-13.35
gr. 1,2
‘A’ week
15.00-15.45
LECTURE
11.20-13.35
gr. 3,6
‘B’ week
15.00-15.45
LECTURE
Thursday
8.00-10.15
gr. 4,5
12.30-14.45
gr. 9,17
13.10-15.25
gr. 11,15
9.30-11.45
gr. 10,14
12.30-14.45
gr. 12,13
8.00-10.15
gr. 7,8
13.10-15.25
gr. 16,18
Friday
Location of practical sessions
The 1st to 4th and the 7th
courses will be held in the
Surgical Teaching Theatre.
The theatre accessed from the
Main Hall of the NET.
Follow the signs down by the
stairs.
Location of practical sessions
The 5th and the 6th courses
will be held in the
laparoscopic training lab, in
1st Seminar room.
Expectations
 Students are required to attend the lectures.
 Attendance is obligatory on practical sessions.
 To participate on the practice is your interest: practical
items you can learn only here. Without required skill you
will not be able to pass exam.
 You are allowed to work only in the group where you
have registered on the Neptun portal.
 Because of limited capacity of operating theatre,
absences can be replaced only after registration by
joining another group.
Expectations
 Practical sessions begin exactly on time.
 Do not be late because you will not be able to
accomplish your task.
 Please note that during each course proper nail hygiene
is necessary (fingertip-high nails).
In addition, the use of nail-polish, artificial nails, any
jewellery, including watches are prohibited.
Who does not respect our requirements will not
take part on the courses and considered absent
without credit.
Expectations
 Handle the surgical instruments properly.
 If an instrument is damaged, cracked or broken
during your practice you should sign a statement.
 You do not need to pay for any damaged instruments
except if your responsibility is clear.
Practical sessions
every second week (3x45 perc = 2 h and 15 min.)
1. Getting acquainted with the operating theatre, ethics and behaviour,
scrubbing-in, and preparation of the surgical field.
Basic surgical instruments and their proper usage.
2. Knotting and basic suturing techniques on the skill model
(simple interrupted suture).
3. Basic suturing techniques on the pig foot
(interrupted sutures).
4. Basic suturing techniques on the pig foot
(continuous sutures).
5. Presentation of the laparoscopic tower, the associated equipment and
laparoscopic instruments.
6. Practicing hand movements using a laparoscopic pelvitrainer.
7. Lessons in tissue dissection and suturing using anesthetised rats
(removal of a „naevus” from the back and median laparotomy).
1. Practical session:
scrubbing-in, gowning and gloving
Goal: To train in the appropriate procedures and methods of gowning
and gloving in preparation for participation in the operating room.
Teacher will provide a brief introduction, demonstrate the
appropriate technique, and provide feedback on each step.
1.
Practical session:
surgical instruments
Goal:
To introduce to the use and names of various surgical instruments.
2.
Practical session
Knot tying/Basic Suturing on a skill model
Goal: To introduce to the technique of knot tying and basic suturing.
Task: to learn the appropriate use of suture equipments (needle holder,
forceps, scissors), tie a two-handed knot, to perform an instrument tie and
the proper technique of simple interrupted suture
3.
Practical session
Basic suturing techniques on the pig foot
simple interrupted suture
interrupted sutures:
Horizontal mattress and vertical mattress (Donati)
4.
Practical session
Basic suturing techniques on the pig foot
Simple continuous suturing
intracutaneous suture
5.
Practical session
Laparoscopic instrumentation
By the end of the session the students will be able to
demonstrate an understanding of laparoscopic instrumentation
6.
Practical session
laparoscopic basic skills
A series of 6 plastic rings are picked up in turn by a grasping forceps from a
pegboard on the surgeon's left, transferred in space to a grasper in the
right hand, then placed around a post on the corresponding right-sided
pegboard.
After all rings are transferred from the left to right, the process is reversed,
requiring transfer from the right to left hand.
Peg transfer

This task is designed to
develop depth perception
and

visual-spatial perception in
a monocular viewing
system and

coordinated use of both the
dominant and nondominant
hands.
7.
Practical session
Wound management on anaesthetized rats
Tissue preparation and wound closure: removal of a
„naevus” from the back and median laparotomy.
The exam

The number of missed practices may not exceed more
than 25%. (only one absence!)

Missing two or more practices, the semester will not be
credited. (only one replacement is possible!)

Basis: lectures and practices

The textbook and DVD can be downloaded on the
Neptun portal {Homepage » Information » Education »
Documentations of faculties}

Additional textbook (offered):
R.M. Kirk: Basic Surgical Techniques ed. Elsevier
The exam
The exam starts with a test of a minimum requirements.
Knowledge of relevant history of surgery
Details of asepsis and antisepsis
Understand the sterile field of the operating room
Theoretical and practical aspects of wound healing, knot
tying, suturing materials, and suturing
Knowledge of general surgical and laparoscopic instruments
You are allowed to continue exam achieving at least 80 %.
The exam
Next step is the practical exam:
Examinees rotate through six stations, where they perform
elements of surgical tasks and are graded by expert examiners
using global rating forms such as respect for tissues, economy of
motion etc. and task-specific checklists.
Workstation:
1.) scrubing- in – gowning and gloving
2.) knowledge of basic surgical instruments
3.) manual knots
4.) making stitches
5.) knowledge of laparoscopic instruments
6.) laparoscopic practice in pelvitrainer
Last step is the theoretical part.
Practical exam- workstation I.
Scrubbing and gowning – aseptic technique
Task: to demonstrate the ability:
• to perform perfect surgical scrub
• assisted-gowning technique
• gloving
understand the sterile field of the operating room
There is no part sterility!!
Evaluation: perfect (20 point), any failure: (0 point)
Practical exam- workstation II.
surgical instruments
Task: to identify, appropriately handle and know the use of:
•
•
•
•
•
Basic cutting/dissecting instruments
Basic clamping/occluding instruments
Basic grasping/holding instruments
Basic retracting/exposing instruments
Needle holders instruments
You should recognize and use 5 surgical
instruments asked randomly: 0-5 point
Practical exam- workstation III.
manual knots
Task: to demonstrate the ability to tie a two-handed knot
(square and surgeons knot)
You will be asked to tie four times two-handed knots.
Based on quality and dinamic performance: 0-10 point
Practical exam- workstation IV.
Basic Suturing
Task:
demonstrate the appropriate use of suture equipment
(needle holder, forceps, scissors)
demonstrate the ability to perform an instrument tie.
demonstrate the proper technique for closing a wound
simple interrupted
simple continuous
horizontal and vertical mattress
intracutaneous suture
You should demonstrate the proper technique of suturing
Based on quality and dinamic performance: 0-10 point
Practical exam- workstation IV.
Basic Suturing
You should demonstrate
the appropriate use of
suture equipment
(needle holder, forceps,
scissors)
Performance: 0 point !!
Practical exam- workstation V.
knowledge of laparoscopic instruments
Task: to identify, appropriately handle
and know the use of laparoscopic
instrumentation
You should recognize and use 5 laparoscopic
instruments asked randomly: 0-5 point
Practical exam- workstation VI.
laparoscopic practice in pelvitrainer
Task: Peg transfer with mid air transfer
Time
0:00-2:30 min
2:31-2:45
2:46-3:00
3:01-3:15
3:16-3:30
3:31-3:45
3:46-4:00
4:01-4:15
4:16-4:30
4:31-4:45
4:46 -
10 point
9
8
7
6
5
4
3
2
1
0
Exercise is scored for
efficiency (time) and
precision (penalty).
Final result
Workstations
Theoretical part (oral)
60 point
40 point
100 point
The final grade is determined by the practical and the
theoretical performance
0-59 points:
60-69 points:
70-79 points:
80-89 points:
90-100 points:
failed (1)
passed (2)
average (3)
good (4)
excellent (5)
DEPARTMENT OF SURGICAL
RESEARCH AND TECHNIQUES
After the successful final exam
students are allowed to participate in the
research program of the department
(Students’ Scientific Association (TDK)
and demonstrator students are also welcome!
Please, contact course director or your teacher!
Operating theater
in which students and other
spectators could watch
surgeons to perform surgery.
Today the term is used as
operating room, the room
that provides a sterile
environment within a
hospital where surgical
operations are carried out.
Operating theater
Gaetano Petrioli (Róma, 1750)
Würzburg 1804
Operating theater - XXI.
SRI International, Menlo Park, CA
January, 2007
Operating theater - XXI.
SRI International, Menlo Park, CA
January, 2007
Operating theater - XXI.
Patient care – Future
SRI International, Menlo Park, CA
January, 2007
Operating team
consists of the chief surgeon,
who directs the surgery;
one or more assistant
surgeons, who help the chief
surgeon;
the anesthesiologist, who
controls the supply of
anesthetic and monitors the
person closely;
the scrub nurse, who passes
instruments to the surgeon;
and
the circulating nurse, who
provides extra equipment to the
operating team.
Anesthesia
The monitoring equipment
and anesthesia used during
surgery are usually kept at
the head of the bed.
The anesthesiologist stands
here to monitor the patient's
condition during surgery.
Depending on the nature of
the surgery, various forms of
anesthesia or sedation are
administered.
Operating room
typically contains a monitor
that displays vital signs, an
instrument table, and an
operating lamp.
Anesthetic gases are piped
into the anesthetic machine. A
catheter attached to a suction
machine removes excess
blood and other fluids, which
can prevent surgeons from
seeing the tissues clearly.
Intravenous fluids, started
before the person enters the
operating room, are continued.
Operating room
All personnel wear
protective clothing called
scrubs. They also wear shoe
covers, masks, caps, eye
shields, and other coverings
to prevent the spread of
germs.
The surgical site is cleansed and surrounded by a sterile
drape.
Location of the
Operating Theatre Suites

Separated from the main flow of hospital traffic

Should be easily accessible from surgical wards
and emergency rooms.

Floor should be covered with antistatic material,

The walls should be painted
with impervious, antistatic paint.
(reduces the dust levels and
allows frequent cleaning)

The surfaces must
withstand frequent cleaning and
decontamination with disinfectant.
Layout of the Operating Theatre
sterile supplies store
Recovery
area
scrub-up
area
clean corridor
Anesthetic
room
Temperature and Humidity

The temperature and the humidity (not less than 55%)
play a important role in maintaining staff and patient comfort.

They must be carefully regulated and monitored.

Ideally, the operating room should be 1ºC cooler than the
outer area.
(In low humidity there is a danger of the production of electrostatic sparks.)
(This aids in the outward movement of air: the warmer air in the outer area rises
and the cooler air from within the operating theatre moves to replace it.)
Laminar flow & ultraclean air
Laminar airflow is designed to move particle free air over the
aseptic operating field in one direction.
It can be designed to flow vertically
or horizontally and is usually
combined with high efficiency
particulate air (HEPA) filters.
HEPA filters remove
particles > 0.3 micron in
diameter with an
efficiency of 99.97%.