THE SYLLABUS OF OPERATIVE SURGERY
Applicable Students: Six-year system oversea students in the department of
clinical medicine.
Class Hours: It takes 32 hours to study this course.
Course Introduction:
Operative Surgery is a basic course of Surgery, with the objectives of introducing
the students to the anatomical aspects of common operations and to lay a foundation
for surgery and its related courses.
The Basic Objectives
After this course, the students should be able to:
1. Set up a sterile area and master sterile techniques.
2. Be familiar with the fundamental operative manipulations and have a
fundamental knowledge of anesthesia.
The emphasis of this course lies on sterile techniques.
Teaching Hours Distribution
NO.
Contents
Experiment
type
Teaching
Hours
1
Aseptic Techniques
fundamental
4
2
Basic Operative Techniques
fundamental
4
3
Venesection
comprehensive
4
4
Procedure of opening and closing the abdomen
fundamental
4
5
Reparation of gastric perforation
comprehensive
4
6
Excision of the cecum
comprehensive
4
7
Suprapubic cystostomy
comprehensive
4
8
Partial resection and anastomosis of the small intestine
comprehensive
4
Total
32
CHAPTER 1: ASEPTIC TECHNIQUES
[Objectives]
1. Understand the importance of aseptic techniques; the concepts of antisepsis and
sterilization; the method and the attention points for the sterilization and antisepsis
of operative necessities.
2. Know the classifications of operative incisions, the degree of the wound healing;
the special preparation for the surgeon to continue with another operation and the
preparation for first-aid operations.
3. Master the classifications of the surgical operations, according to the degree of
contamination in the operative fields.
4. Master the general preparation of the operative staff and patient.
5. Know the shapes and names of the basic operative instruments and master the
application of common instruments.
6. Understand the source of bacteria in the operative site and be able to apply
effective methods of prevention.
[Contents]
1. General introduction: the aseptic techniques and history of aseptic techniques; the
concepts of asepsis, aseptic ware, antisepsis and sterilization.
2. The classification of operations. The record of healing following incision and the
format of operative records.
3. The source of bacteria in the operative site and its prevention:
(1) Air.
(2) nasopharynx.
(3) Skin.
(4) Operative necessities.
(5) Infective region and incision of an organ with a cavity.
4. The method of sterilization and antisepsis for operative instruments.
(1) Sterilization: Steam sterilization, boiling sterilization and open flame
sterilization; the idiographic method and attention points for the sterilization
of the operative instruments.
(2) Antisepsis: the effective concentration of various disinfectants and the
idiographic method and attention points for the disinfection of operative
instruments.
5. Preparation of personnel for operation.
(1) General preparation: cap and mask.
(2) Scrubbing: scrubbing with soap and soaking with alcohol or bromogera mine;
scrubbing with povidin-iodine.
(3) Gowning; gloving.
(4) The method of changing clothes and scrubbing for another operation and an
emergency operation.
6. The preparation of the operative site.
(1) The preparation of the operative-site skin.
(2) The scope of disinfection, methods and attention points for the operative site
skin.
(3) The importance and significance of draping, principles, methods and attention
points.
7. The aseptic requirements during the course of an operation.
(1) The scope of an aseptic site.
(2) Delivering the ware on the stable.
(3) Dealing with a broken glove and contamination.
(4) Dealing with contaminated ware.
(5) The exchange of surgeons and the requirements for visitors.
CHAPTER 2: BASIC OPERATIVE TECHNIQUES
[Objectives]
1. Know the main content of the basic operative techniques: incision, dissection,
hemostasis, tying knots, suture, drainage, cutting and removing sutures.
2. Know the types of knots.
3. Be skilled in the method of one hand tie (right hand) and instrument tie.
4. Master the idiographic operative technique of incision, suture, hemostasis by
ligation, cutting and removing sutures.
5. The function and position of the operative staff.
[Contents]
1. Incision
(1) The principle and requirements of incisions.
(2) The method of incisions according to the different layers: skin and
subcutaneous tissues, muscle, nerves, vessels, and peritoneum.
2. Dissection
(1) The concept of dissection.
(2) The classification of dissection: sharp incision and blunt incision.
(3) The application of sharp and blunt dissections.
3. Suture
(1) The concept of suturing.
(2) The principle of suturing.
(3) The method of suturing and its application:
① Simple closure: interrupted suture, continual suture, blanket suture, figure
of eight suture and tension relaxing suture.
② Inverting suture: Connell suture, Cushing suture, Lembert suture, and
purse-string suture.
③ Everting suture: vertical mattress suture and horizontal mattress suture.
4. Ligation
(1) The importance of ligation.
(2) The classifications of ligation: simple Knots, square Knots, triple Knots,
surgical Knots, slip Knots, false Knots.
(3) The common methods for ligation: by single hand (usually by right hand), two
hand tie, and instrument tie.
5. Hemostasis
(1) The importance of hemostasis.
(2) The common methods for hemostasis: Hemostasis by tying, Hemostasis by
packing and pressure, Hemostasis with local medicine, Hemostasis by electric
coagulation, Hemostasis with a tourniquet.
6. Cutting sutures and removing sutures: the methods and attention points during
cutting sutures; the time, methods and attention points for the time of
removing
sutures.
7. Drainage:
(1) The importance and application of drainage.
(2) The principle of drainage and how to choose the drainage materials.
(3) The common drainage materials: a strip of rubber, gauze strip, rubber tube,
and cigarette drain.
8. Exposure of the operative site.
(1) The importance of exposure.
(2) The factors which can affect the exposure of operative site.
CHAPTER 3: VENESECTION
[Objectives]
1. Master the combination of sharp and blunt dissections via the two operations:
tracheotomy and exposure of the femoral artery.
2. Know the structure of the femoral triangle and the relationship between the
femoral artery, femoral vein and femoral nerves.
3. Get training of the routine procedures of venesection.
4. Become familiar with the procedure of tracheotomy and the exposure of the
femoral artery.
[Contents]
1. Exposure of the femoral artery
(1) Anatomy: the structure of the femoral triangle and the relationship between
the femora artery, vein and nerves.
(2) The application of femoral artery, vein femoral and femoral nerves.
(3) The procedure.
2. Venotomy
(1) The application of venectomy.
(2) The procedure.
CHAPTER 4: PROCEDURE OF OPENING AND CLOSING
THE ABDOMEN
[Objectives]
1. Know the structure, blood supply, nerve control and lyphocinesia of the
2. Anterior abdominal wall.
3. Master the principle of choosing an incision type, master the classification and
application of common incisions of the abdomen.
[Contents]
1. Anatomy: the tissue structure, blood supply, nerve control and lyphocinesia of the
anterior abdominal wall
2. The principles of choosing an incision
3. Classification and application of common incisions of the abdomen
(1) Vertical: median incision, paramedian incision, transtectus incision and
pararectus incision
(2) Oblique: Mcburney`s incision and subcostal incision
(3) The union incision
4. The procedure of abdominal incisions (instance: transrectus incision)
CHAPTER 5: REPARATION OF GASTRIC PERFORATION
[Objectives]
1. Training of the sterile technical manipulations.
2. Practice of the procedures of the opening and closing of the abdominal cavity.
3. Training of the routine procedures of the reparation of gastric perforations.
[Contents]
1. Anatomy of the stomach
2. Reparation of gastrointestinal perforation and suture method.
CHAPTER 6: EXCISION OF THE CECUM
[Objectives]
1. Master the anatomic structure and position of the appendix.
2. Practice the routine procedures for appendectomy (imitating human appendectomy)
by excision of the cecum.
3. Master the anatomic structure of the McBurney’s incision.
[Contents]
1. Anatomy: know the condition and structure, position and vermiform, blood supply
and nerve control and lyphocinesia of the appendix
2. The classification of appendectomy: direct appendectomy and antidromic
appendectomy.
3. Direct “appendectomy”
CHAPTER 7: SUPRAPUBIC CYSTOSTOMY
[Objectives]
1. Training of the fundamental surgical techniques.
2. Practice of the procedures of opening and closing the abdominal cavity.
3. Training of the routine procedures of suprapubic cystostomy.
[Contents]
1. The anatomical relationship between the bladder and the peritoneum
2. The manipulation of suprapubic cystostomy.
CHAPTER 8: PARTIAL RESECTION AND ANASTOMOSIS
OF THE SMALL INTESTINE
[Objectives]
1. Revision of the anatomy of the small intestine
2. Master the method and principle of partial resection
3. Master the procedure, method and attention points for anastomosis of the small
intestine (end to end)
4. Master the combination of basic operative techniques, especially the techniques of
inverting sutures.
[Contents]
1. Anatomy: the position, modality, and blood supply of the small intestine
2. The classification of anastomosis of the small intestine: end to end, end to side, and
side to side
3. The process of partial resection and anastomosis of the small intestine (end to end)
for dogs.
REFERENCES
1. Luo Junsheng，Textbook of
Clinical skills，2011
2. Ao Dingchun, An Expermental Guide of Surgical Operative, 2001
3. Wu Zaide, Textbook of Surgery, 7th Edition, 2008