LESSON 3
Types of surgeries and
anaethesia, Surgical
instruments and suture
materials
OBJECTIVES
By the end of this lesson, you should be able to:
1. Describe list and describe different types of
surgeries
2. List and describe different type of anaesthesia
3. Classify surgical instrument
4. Classify suture materials, describe their tensile
strength and sizes and indicate where they are
used
Types of surgeries
Surgery can be classified depending on
1. magnitude of the operation - depending on the
seriousness of the illness, the parts of the body
affected, the complexity of the operation, and the
expected recovery time into major, minor or day
case surgery
2. Technique used to perform the surgery
3. Purpose of the surgery
4. Urgency – Elective (cold), urgent and emergency
Major Surgery
• These are operations which take a long to
perform, have long recovery period, may
involve a stay in intensive care or take several
days in the hospital post operatively.
• There is a higher risk of complications after
such surgeries.
• They include but are not limited to surgeries
of the head, neck, chest, and abdomen.
Major surgery cont ….
In children, types of major surgery may include, but
are not limited to, the following:
– removal of brain tumors
– correction of bone malformations of the skull and
face
– repair of congenital heart disease,
transplantation of organs, and repair of intestinal
malformations
– correction of spinal abnormalities and treatment
of injuries sustained from major blunt trauma
– correction of problems in fetal development of
the lungs, intestines, diaphragm, or anus.
minor surgery
• These are operations which take a short time to
perform, involve non vital organs, have short
hospital stay and rarely complicate,
• Examples of the most common types of minor
surgeries may include, but are not limited to, the
following:
– placement of ear tubes
– hernia repairs
– correction of bone fractures
– removal of skin lesions
– biopsy of growths
Depending on the technique used
1.
2.
3.
4.
5.
6.
Conventional surgery
Minimal access surgery
Keyhole surgery
Laparoscopic
Microsurgery
Endoscopic surgery
Purpose of the surgery
•
•
•
•
•
Diagnostic surgery
Exploratory surgery
Reconstructive surgery
Cosmetic surgery
Transplant surgery
Day care
• A growing number of conditions needing
operation can now be treated by day surgery,
usually at the day surgery unit of a hospital.
• The patient arrives, has the operation and
goes home on the same day.
• The hospital will be able to answer any
questions patients may have about specific
arrangements for day surgery.
Elective surgery
• This term is used for operations that are planned in
advance, to distinguish them from operations
performed as an emergency.
Emergency surgery
Operations that require immediate admission to
hospital, usually through the accident and
emergency department.
They are usually performed within 24 hours, and may
be done immediately or during the night for serious
or life-threatening conditions.
Examples include acute appendicitis; haemorrhage,
perforation or obstruction of the intestines; major
trauma, including multiple fractures; and a ruptured
spleen or aneurysm, ectopic pregnancy.
Keyhole surgery
• Advances in surgical treatments have enabled many
conditions to be treated by "keyhole surgery",
which involves very small incisions and less pain
and trauma for the patient than in conventional
surgery.
• The surgeon can see the area to be operated on by
looking through a fine tube with a light on the end
(known as a fibre optic light source) and carries out
the operation by using special instruments inserted
through the tube.
• The operations are carried out under anaesthesia.
Laparoscopic surgery
This is similar to keyhole surgery but refers especially
to operations performed inside the abdomen and in
the peritoneum (the lining of the abdomen).
Microsurgery
Surgeons use a powerful magnifying device
(microscope) to enable them to operate on tiny
structures such as small arteries, nerves, the bones
of the middle ear or inside the eye.
Delicate and extremely small instruments are used.
Organ Transplant Surgery
Where a patient has a failing organ, for example a
diseased kidney, it is sometimes possible to replace
it with a healthy one donated by another human
being.
In the case of a kidney the donor may be a relative or
someone who has recently died and had completed
an organ donor card requesting that their body be
used to help others.
Examples of organs that can be transplanted are the
liver, kidney and the heart
ANAESTHESIA
• Anaesthesia is a medical procedure used to
make patients undergoing surgery
comfortable.
• It involves the use of medicines to block pain
sensations (analgesia) during surgery and
other medical procedures.
• Anesthesia also reduces many of your body's
normal stress reactions to surgery
• An anaesthetist (person trained in
anaesthesia) normally does the procedure
Types of Anaesthesia
Anaesthesia is classified into:
1. General anaesthesia
2. Regional anaesthesia
– Spinal
– Epidural
– Peripheral nerve block
3. Local anaeshtesia
General Anaesthesia (GA)
GA involves drugs which cause unconsciousness give
by inhalation (anaesthetic gases) or intravenously.
The gases are given via an endotracheal tube (ETT) or
a laryngeal mask placed on the opening of the
larynx.
Often the patient is paralysed by giving a muscle
relaxant to reduce the muscle tension during
surgery, in which case the patient breathing is taken
over by a machine called a ventillator
Often anaesthesia is induced via the intravenous
route, maintained through inhalation and
supplemented intravenously.
GA Cont ….
It affects the brain as well as the entire body.
The patients are completely unconscious and
do not feel pain during the surgery.
In addition, general anesthesia may cause
forgetfulness (amnesia) in postoperative
period.
Regional Anaesthesia
• Regional anaesthesia involves injection of a local
anesthetic around major nerves or the spinal cord
to block pain from a larger but still limited part of
the body.
• Patients on regional anaesthesia are usually given
sedatives to help them sleep or relax during
surgery.
• Major types of regional anesthesia include:
1. Spinal anaesthesia
2. Epidural anaesthesia
3. Peripheral nerve blocks
Spinal anaesthesia
• Spinal anaesthesia involves injecting a local
anaesthetic drug in the subarachnoid space
into the cerebrospinal fluid.
• It produces profound numbness and loss of
movement in the lower part of the body
• The LA is introduced into the subarachnoid
space via a lumbar puncture (LP) which is
made by a fine spinal needle after LA is
infiltrated in the skin of the back
Epidural Anaesthesia
Epidural anaethesia involves identification of the
spinal epidural space and injection of LA into the
space the onset of anaesthesia is slow and is
infrequently used alone.
Most often a fine tube called an epidural catheter is
introduced into the space to give pain relief after
the operation to infuse analgesic. This is call spinal
analgesia.
Using epidural anaesthesia usually give better pain
relief post operatively.
This is particularly important in major operations and
in patients with other illnesses that cause pain
Peripheral Nerve Blocks
• A local anesthetic is injected near a specific
nerve or group of nerves to block pain from
the area of the body supplied by the nerve.
• Nerve blocks are most commonly used for
procedures on the hands, arms, feet, legs,
or face.
• Usually used with GA to give longer lasting
pain relief
Local Anaesthesia (LA)
Involves injection of a local anesthetic directly
into the surgical area to block pain sensations.
It is used only for minor procedures on a limited
part of the body.
The patient may remain awake, although the
patient may be given a sedative to help them
relax or sleep during the surgery
Surgical Instruments
A surgical instrument is a specially designed tool or
device for performing specific actions of carrying
out desired effects during an operation, such as
modifying tissues, or to provide access for viewing
it.
Some surgical instruments are designed for general
use in surgery, while others are designed for a
specific procedure or surgery.
Accordingly, the nomenclature of surgical instruments
follows certain patterns, such as a description of the
action it performs, the name of its inventor(s), or a
compound scientific name related to the surgery
Classification of Surgical Instruments
There are several classes of surgical instruments:
• Graspers, such as forceps
• Clamps and occluders for blood vessels and other
organs
• Retractors, used to spread open skin, ribs and other
tissue
• Distractors, positioners and stereostatic devices
• Mechanical cutters (scalpels, lancets, drill bits,
rasps, trocars, ligature, etc.)
Surgical instruments cont …
• Suctions tips and tubes, for removal of bodily fluids
• Dilators and specula, for access to narrow passages
or incisions
• Sealing devices as surgical staplers, ...
• Irrigation and injection needles, tips and tubes, for
introducing fluid
• Tyndallers, to help "wedge" open damaged tissues
in the brain.
• Powered devices, such as drills and dermatomes
Surgical instruments cont…
• Scopes and probes, including fiber
endoscopes and tactile probes
• Carriers and appliers for optical, electronic
and mechanical devices
• Ultrasound tissue disruptors, cryotomes and
cutting laser guides
• Measurement devices, such as rulers and
calipers
Suture Materials
• Surgical suture is a medical device used to hold
body tissues together after an injury or surgery.
• It generally consists of a needle with an attached
length of thread.
• A number of different shapes, sizes, and thread
materials have been developed over time.
• In modern surgery, many kinds of ligature and
suture materials are used.
• All sutures can be grouped into two classes:
1. Non-absorbable sutures
2. absorbable sutures
Non-absorbable sutures
These are sutures that cannot be absorbed by the
body cells and fluids in which they are embedded
during the healing process.
When used as buried sutures, these sutures become
surrounded or encapsulated in fibrous tissue and
remain as innocuous foreign bodies.
When used as skin sutures, they are removed after
the skin has healed.
The most commonly used sutures of this type and the
characteristics associated with each are listed
below:
Non absorbable suture cont …
Non-absorbable sutures are made of special silk or
the synthetics polypropylene, polyester or nylon.
Stainless steel wires are commonly used in orthopedic
surgery and for sternal closure closure in cardiac
surgery.
These may or may not have coatings to enhance their
performance characteristics.
Non-absorbable sutures are used either on skin
wound closure, where the sutures can be removed
after a few weeks, or in stressful internal
environments where absorbable sutures will not
suffice.
Examples of non-absorbable sutures
Silk - frequently reacts with tissue and can be “spit”
from the wound.
Cotton - loses tensile strength with each
autoclaving.
Linen - is better than silk or cotton but is more
expensive and not as readily available.
Synthetic materials (e.g., nylon, dermalon) - are
excellent, particularly for surface use. They
cause very little tissue reaction. Their only
problem seems to be the tendency for the knots to
come untied.
Synthetic non-absorbable suture cont…
Nylon is preferred over silk for face and
lip areas because silk too often causes tissue
reactions.
Rust-proof metal
Usually stainless steel wire
Has the least tissue reaction of all suture
materials and is by far the strongest.
The primary problems associated with it are that it is
more difficult to use because it kinks and that it
must be cut with wire cutters.
Absorbable sutures
Absorbable suture materials include the original
catgut as well as the newer synthetics polyglycolic
acid (vicryl), polylactic acid, polydioxanone(PDS),
and caprolactone.
They are broken down by various processes including
hydrolysis (polyglycolic acid) and proteolytic
enzymatic degradation.
It is this characteristic that enhances their use
beneath the skin surfaces and on mucous
membranes.
Depending on the material, the process can be from
ten days to eight weeks.
Absorbable sutures cont …
They are used in patients who cannot return for
suture removal, or in internal body tissues.
In both cases, they will hold the body tissues together
long enough to allow healing, but will disintegrate
so that they do not leave foreign material or require
further procedures.
Occasionally, absorbable sutures can cause
inflammation and be rejected by the body rather
than absorbed.
Surgical gut fulfills the requirements for the
perfect suture i.e ease of manufacture, tensile
strength, and variety.
Manufacture of catgut
Though it is referred to as “catgut,” surgical gut is
derived from the submucosal connective tissue
of the first one-third (about 8 m) of the small
intestine of healthy government-inspected sheep.
The intestine of the sheep has certain characteristics
that make it especially adaptable for surgical use.
Among these characteristics is its uniformly finegrained tissue structure and its great tensile
strength and elasticity.
Tensile strength of sutures
Suture sizes are defined by the United States
Pharmacopeia (U.S.P.).
This suture material is available in sizes of #6-0 to #0
and #1 to #4, with #6-0 being the smallest diameter
and #4 being the largest.
The commonly used catgut sizes in general surgery
are #4-0 to #2
The tensile strength increases with the diameter of
the suture.
Modern sutures range from #5 (heavy braided suture
for orthopedics) to #11-0 (fine monofilament suture
for ophthalmics).
Needles
• Traumatic needles are needles with holes or eyes
which are supplied to the hospital separate from
their suture thread.
• Atraumatic needles with sutures comprise an
eyeless needle attached to a specific length of
suture thread.
• The suture manufacturer swages the suture thread
to the eyeless atraumatic needle at the factory.
• There are several shapes of surgical needles. These
include straight, 1/4 circle, 3/8 circle, 1/2 circle, 5/8
circle, compound curve, half curved, and half
curved at both ends of a straight segment.
Needles cont …
Needles may also be classified by their point geometry;
examples include:
• Taper (needle body is round and tapers smoothly to a
point)
• Cutting (needle body is triangular and has a sharpened
cutting edge on the inside)
• Reverse cutting (cutting edge on the outside)
• Trocar point or tapercut (needle body is round and tapered,
but ends in a small triangular cutting point)
• Blunt points for sewing friable tissues
• Side cutting or spatula points (flat on top and bottom with
a cutting edge along the front to one side) for eye surgery
Conclusion
Different types of surgeries – major,
minor, conventional, minimal access,
endoscopic
Types of anaesthesia – GA, RA, LA
Surgical Instruments - Classification
Suture Materials – Classification, thread
tensile strength and sizes, needles sizes
and types
3/22/2016