A Practical Guide to Surgical Instruments, X-rays and Operative Interventions Ajay Kumar Agrawal, Neelabh Agrawal, Sneha Agrawal
INDEX
ABCDEFGHIJKLMNOPRSTUVWXZ
A
Abdomen anteroposterior view, X-ray 70
Abdominal
drain kit 47
viscera trauma 49
wall reinforcement 64
Abscess 125
different types of 102
drainage 101
formation 108
Acalculous cholecystitis 129
Achalasia cardia 76, 77
Acidic urine 82
Acrocyanosis 104
Acute paronychia 102
Adhesive bandage 66
Air bubble 80
Allan Park's operation 125
Allis tissue forceps 10
Allison's retractor 22
Anal atresia 91
Anal fissure, surgery for 126
Anal fistula, surgery for 127
Anorectal
abscess 102
anomaly 91
Antegrade method of cholecystectomy 129
Appendicectomy 114
Aseptic suction 113
Auchincloss modification 134
Autoclaving 3
Axillary
abscess 103
dissection 135
vein 135
B
Babcock tissue forceps 11
Backhaus towel (corner) clip 8
Bags 55
Balfour's retractor 23
Bandages and adhesive tapes
cotton 65
crepe 65
elastic adhesive 66
Hipore surgical type 66
Bard Parker knife handle 8
Barium enema
contraindication 78
indication 78
types 78
air contrast study 78
double contrast 78
single contrast study 78
Barium meal 76
Barium swallow 76
Barron's banding 125
Bassini's repair, modified 117
Bell's nerve 135
Bent inner tube appearance 75
Bilateral renal calculi 81
Biliary ducts 79
Bird's beak appearance 75
Bladder lump 141
Bleeding 110
disorders 106
from vessels 100
Blood transfusion set 53
Bone cutter 31
Bowel
anastomosis 60
obstruction 76
perforation 76
Breach of peritoneum 105
Breast
abscess 102
tissue 135
Bronchopneumonia 100
Buerger's disease 104
Butterfly cannula 54
C
Caecal volvulus 75
Calcaneum bone, level of 95
Calcified
bladder polyp 84
lymph nodes 84
Calcium oxalate stones 82
Calot's triangle 130
proceeding 129
Cannon ball metastases, differential diagnosis 89
Cannula 32
Capsule of fibroadenoma 136
Carcinoma
esophagus 77
upper airway tract 112
Catch lock 7
Catgut
chromic 60
plain 60
Catheter wings 62
Cattle's intestine, serosa of 60
Cellulitis 100
Central venous
catheter 39
line 106
Cephalic vein 135
Cervical collar incision 111
Chagas disease 77
Cheatle's forcep 6
Chest
cavity 57
complications 100
wall, operative steps 134
X-rays 89
Chilaiditi's sign 72
Cholangitis 129
Cholecystectomy 7
Choledocho-duodenostomy anastomosis 43
Choledocholithiasis 129
Choledocholithotomy 18
Chronic immunosuppression 129
Chronic parotitis 109
Cidex 3
Circular disc 119
Circumcision
anesthesia 146
indications 146
position 146
Closure of skin incision 60
Coat of savlon 99
Coconut scrotal dressing 145
Coffee bean 75
Coin-gas shadow 92
Colon 76
Colonic
gas shadows 73
pseudo-obstruction 75
Color coding 37, 42
Colostomy 94
anesthesia 121
choosing the site of 121
classification 121
closure 122
complications and postoperative management 122
indication 121
position 121
Condom catheter 36
Conjoint tendon 118
Cooper's ligament repair 117
Corrugated drain 145
Corrugated rubber drain 50
Cotton bandage 65
Crepe bandage 65
Cricopharynx 75
Cupola sign 72
Cut capsular edges 142
Cystine stones 82
Cystogram phase 86
Cystolith 84
Cystolithotomy forceps 17
Czerney's retractor 20
D
Dahl Froment's sign 75
Darn repair 117
Deaver's retractor 21
Deep cervical fascia 111
Deep vein thrombosis 100
Deep venous thrombosis 106
Descending urethrography 88
Desjardin's choledocholithotomyforceps 18
Desjardin's forceps 131
Diffuse esophageal spasm 77
Digital skiagram
abdomen AP view 72
chest P-A view 71
Digital X-ray 69
Dilated contrast filled posteriorurethra 88
Disinfection 3
Dissect lumbar sympatheticchain 25, 105
Distal bowel anastomosis 121
Distal loopogram
indications 94
method 94
Diverticula 76
Domes diaphragm 70
Double
barrel ileostomy 118
breasting of inguinal canal 117
hook skin retractor 23
Doyen's
gastrointestinal clamp 28
retractor 22
towel clip, uses 8
Drainage fluid 57
Drains 47
Drip chamber 52
Drip sets 51
Duodenal fistula 131
Duodenostomy 56
Duodenum 105
delineated 79
E
Elastic adhesive bandage 66
Emphysematous cholecystitis 129
Empyema thoracis 49, 90, 137
End ileostomy 118
Endorectal advancement flap, indications 128
Esophageal
malignancy 77
sphincter fails 77
stricture 77
Esophagus 77
Ethilon 60
Excision of lipoma
anesthesia 149
complications 149
methods 149
position 149
Excision of sebaceous cyst
anesthesia 149
complications 150
methods 149
position 149
Exploration of common bile duct 131
External jugular vein 110
F
Facial nerve 110
Faecoliths 82
Farabeuf's respirator 31
Fasciovenous plane of Patey 110
Fecal incontinence 126
Feeding jejunostomy
anesthesia 123
bag 56
indications 122
position 123
types of 123
Fever 100
Fibroadenoma 48, 136
capsule of 136
enucleation 136
Fibrous stricture 73
Filaments 58
Finger dilatation of anus 126
Firearm injury 95
Fissure formation 125
Fissurectomy 126
Fistula 92
formation 125
in-ano 93
Fistulectomy 127
Fistulogram 92
Fistulotomy 127
Flail chest 90
Flatus tube 44
Fluid filter 52
Foley balloon catheter, uses of 35
Foley catheter 55, 88, 144, 148
complications 148
contraindications 148
in females 148
indications 148
methods 148
position 148
Football sign 72
Forceps 10–16
Allis tissue forceps, uses 10
Babcock forceps, uses 11
hemostatic artery forceps, uses 12
Kocher forceps, uses 11
Lahey’ forceps, uses 16
Lane's tissue forceps, uses 14
lister sinus forceps, uses 15
plain forceps, uses 13
Russian forceps, uses 14
toothed forceps, uses 13
Vas holding forceps, uses 16
Foreign body 73
in larynx 112
X-rays 95
Formaldehyde 3
Frey's syndrome 110
Frost bite 104
Fumigation 3
G
Gall stones 73
Gallbladder dyskinesia 129
Gallstone pancreatitis 129
Ganglionic cells 77
Garrotte mark 111
Gastric
aspirate 41
hemorrhage 41
Gastroesophageal junction 41
Gastrointestinal X-rays 70
Gastrosplenic ligament 124
Gastrotomy 56
Genital vessels 105
Genitourinary X-rays 81
Giant prosthetic reinforcementof visceral sac 118
Good knotting quality 58
Goodsall's rule 128
Gradual anal sphincter stretching 124
H
Hartman's procedure 121
Head and neck, operative steps 109
Hematoma 147
Hemithyroidectomy 110
Hemorrhoid 124
Hemorrhoidectomy 7, 124
Hemostasis 135, 141, 142
Hemostatic artery forceps
Halsted's Mosquito forceps 12
Spencer Wells artery forceps 12
Hemothorax 49, 138
chest injury 90
differential diagnosis 90
Hepatobiliary 79, 129
tract 79
triangle 130
Hepatorenal space 47
Hernia 73
repair 64
Hernioplasty types 118
Herniorrhaphy 117
Herniotomy 116
High fistula 127
Hilton's method of abscessdrainage 101
Hipore surgical tape 66
Hirschsprung's disease 121
Humby's skin grafting knife 30
Hydrocele, surgery for 144
Hydropneumothorax 90
Hyperhydrosis 104
Hypersplenism 124
Hypertrophic scar 112
Hypoparathyroidism 112
I
Ileal loops 73
Ileostomy 94, 118
anesthesia 122
aperture 119
choosing the site of 119
classification 118
complications 122
indication 118, 122
methods 122
position 122
procedure of 120
siting of 119
Ileum 119
Inbuilt filter 63
Incentive respirometer 63
Incisional hernia 48
formation 100
Indinavir stones 82
Infant feeding tube 42
Inferior thyroid artery 111
Inflammatory bowel disease 73
Inflammatory disease 109
Infuse sensitive medications 53
Infusion tubing 52
Inguinal hernia, surgery for 115
Inguinal ligament 118
Inguinal orchidectomy 118
Inherent capacity of suture 58
Injection
port cap 62
related abscess 100
site 52
Injury to lumbar veins 105
Instrument
how to describe 5
how to hold 4
parts of surgical 4
blades 4
catch 4
finger bows 4
ratchet 4
shaft 4
shank 4
sterilization of 3
different methods of 3
used start of surgery 6–9
Intercostal
chest drain 49
drain bag 57
drain placement 136
drainage 90
muscles 137
Internal jugular approach
complications 107
indications and contraindications 107
methods 107
position 107
Internal spermatic fascia 145
Internal sphincter 126
Internal sphincterotomy 126
Internal volvulus 73
Intestinal clamps 28
Intraoperative complications 100
Intravenous cannula 61
sizes of 62
Intravenous
drip set, parts of 52
urography 85
contraindications 86
indication 86
limitations 86
method 86
Intussusception 73
J
Jaboulay's procedure 145
Jejunal loops 73
Jejunostomy 35, 43, 56
K
Kehr's T-tube 43
Kelly's rectal speculum 29
Kidney position 139
Kidney tray 9
Kinking 137
Kocher maneuver 131
Kocher's
hemostatic forceps 11
incision 129
Kuntz operation 118
L
Lacunar ligament 118
Lahey's forceps 16
Lane's tissue forceps 14
Langenbach's retractor 19, 141
Laparoscopic cholecystectomy
anesthesia 132
contraindication 132
indication 132
position 132
procedure of 133
disadvantages of 132
Large atraumatic eyes 47
Large bowel loop 74
Laryngeal diphtheria 112
Left paravertebral region 81
Lichtenstein tension free hernioplasty 118
Lister sinus forceps 15
Lister urethral dilator 30
Long thoracic nerve 135
Longo's stapler hemorrhoidectomy 125
Loop ileostomy 118
Loops of large bowel 74
Lord's
plication 145
procedure 126
Lothiessan's repair 117
Low fistula 127
Lubricate flatus tube 44
Luer lock stopcock 54
Lumbar ganglia 105
Lumbar sympathectomy 104
anesthesia 104
forceps 25
indications 104
position 104
chain 105
Lumen of intestine 73
Lung injury 49
Lymph node biopsy
anesthesia 150
complications 150
indications 150
methods 150
position 150
Lymphedema 135
Lytle's repair 117
M
Malecot catheter 37
Mastectomy, types of 135
Maxillofacial injuries 112
Mayo's clip 8
Mesh herniorrhaphy 118
Metallic suction cannula 29
Metallic urethral bougie 30
Metastatic lymph nodes 77
Micro drip set 53
Micturating cystourethrography 88
Milligan morgan operation 124
Milligan triangle of exposure 125
Millin's operation 142
Minimal tissue reaction 58
Minivac 48
Modified radical mastectomy 5
Mollison's self-retaining mastoid retractor 24
Monofilament polyamide suture 60
Morris’ retractor 20
Morrison's pouch 47
Moynihan's gastric occlusion clamp 28
Myenteric plexus 77
N
Nasogastric tube 40, 41
Navicular fossa 87
Near-total thyroidectomy 110
Neck
abscess 103
hematoma 112
Needle
description of 59
edge 59
eye 59
shape 59
tip 59
holder 26
Nelaton catheter 37
Neoplastic lesions 73
Nephrectomy 139
anesthesia 139
indication 139
position 139
position of 139
Nephrogram phase 86
Nephrolithotomy 18
Nerves and vessels 104
Northern exposure sign 75
Nylon suture 128
O
Oblique incision 105
Oblique subcostal incision 129
Obstructive jaundice 129
Open cholecystectomy 129
Open prostatectomy 140
Oro-facio-maxillary injuries 45
Oxalate stones 82
P
Parathyroid injury 112
Paravertebral region 85
Parietal pleura 49
Parker-Kerr clamp 28
Parotid abscess 102, 109
Parotidectomy 109
Payer's gastric crushing clamp 28
Peanut swab 130
Pediatric chamber 51
Pelvic cavity 47
Pelvicalyceal system 85
Pelvi-rectal fistula 127
Penrose drain 128
Perianal area 93
Perianal region 93
Periosteal elevator 31
Peripheral vascular disease 104
Peritoneal
breach 72
covering 141
dialysis 72
Peritoneum 99, 105
Phleboliths 84
Pigtail catheter 55
Pivot 52
Platysma 111
Pleomorphic adenoma 109
Pleural effusion 49, 90, 137
Pneumoperitoneum 70–72, 132
Pneumothorax 49, 138
Polydioxanone 60
Polyglactin (Vicryl) suture 60
Polypropylene suture 60
Posterior lieno-renal ligament 124
Posterior sagittal anorectoplasty 92
Preoperative preparation
antibiotics 99
clinical evaluation 99
informed consent 99
nil per oral 99
part preparation 99
pre anesthetic check up 99
tetanus prophylaxis 99
Preperitoneal repair 118
Prevent injury of ducts 136
Proctoscope 29
Prolene 60
mesh 64
suture 128
Prostatectomy, techniques 140
Prostatic capsule 142
Protector cap 52
Pseudoachalasia 77
Pubic
symphysis 84
tubercle 118
Pulmonary embolism 100
Pyelo-lithotomy forceps 18
Pyoperitoneum 47
R
Radical mastectomy, modified 134
Radical parotidectomy 109
Rampley's sponge holding forceps 7
Randall nephro/pyelo-lithotomy forceps 18
Rat tail filling defect 77
Raynaud's disease 104
Reactionary hemorrhage 125
Rectoanal surgeries 65
Rectum ends
above level of levator ani complex 92
below level of levator ani complex 92
Rectus sheath 130
closure 60
Recurrent laryngeal nerve injury 112
Regulator 52
Renal
calculi 82
infections 139
injury 139
pedicle 139
stones 81
differential diagnosis 82
tumors 139
Respiratory failure 112
Retractors 19
Retrograde technique 129
Retroperitoneal hematoma 105
Retropubic prostatectomy 142
advantages of 142
anesthesia 142
contraindication 142
indication 142
position 142
Right angle
dissection forceps 130
mixter hemostatic forceps 16
Rigler's sign 72
Romovac suction drain 48
Ruptured appendicular abscess 47
Ryle's tube 42
S
Savlon in operation theater 6
Scalp vein set 54
Scalpel vasectomy 147
Scanlon's modification 134
Scissors 27
Heath's suture cutting scissors 28
Mayo's scissors 27
Metzenbaum scissors 27
Scleroderma 77
Secretory phase 86
Self-retaining
abdominal wall retractor 23
Joll's thyroid retractor 24
Septicemia 100
Seton procedure 127
Shouldice's repair 117
Sickle cell disease 129
Sigmoid volvulus 74
Silk suture 60
Siloderm 120
Sinogram 92
Sinus 92
formation 108
flaps of 135
Skin
incision 135
stapler 64
Small bowel obstruction 73
Small transverse suprapubic incision 144
Sodium diatrizoate 86
Soft tissue of perianal 93
Sperm granuloma 147
Spike 52
Spinal anesthesia 100, 126
Spleen 124
Spleen syndrome 124
Splenectomy
anesthesia 123
complications 124
indications 123
methods 124
position 123
Splenic
trauma 123
vein 124
Spleniculii 124
Splenosis 124
Stamm type 123
Steel wire 128
Sterilization, different methods of 3
Stitch
abscess 100
granulomas 112
Stoma
diameter 120
fashioning of 120
Stone retrieval forceps 17
Struvite (triple phosphate) stones 82
Subclavian approach 106
complications 107
contraindication 107
methods 107
Subcostal incision 140
Subcutaneous tissue 60, 99
Subtotal thyroidectomy 110
Suction catheter 38
Superficial parotidectomy 109
Superior thyroid vessels 111
Supine film signs ofpneumoperitoneum 72
Suprapubic cystolithotomy
anesthesia 143
complications 143
indication 143
methods 143
position 143
Suprapubic cystostomy 143
contraindications 144
indication 143
Suprapubic transvesical prostatectomy
anesthesia 141
position 141
Suprapubic trocar 32, 144
Sutures 58
characteristics of 58, 60
classification 58
code 59
description of 58
examples of various types of 60
length of 59
non-important descriptions 59
number of 59
types of 59
used in closing of different layers of incision 99
Swallow X-ray of esophagus 75
Syndromes
auriculotemporal 110
Dupuy's 110
Frey's 110
spleen 124
transurethral 143
T
Taper cut 59
Temporo-parotid fascia 110
Terminal ileum 119
Thoracolumbar fascia 140
Thoracotomy 90
Thrombophlebitis 108
Thumb rest 31
Thyroid
crisis 112
insufficiency 112
isthmus lies 113
lobes 111
Thyroidectomy 110
anesthesia 111
position 111
types of 110
Tissue repairs, types of 117
Total extraperitoneal repair 118
Total parotidectomy 109
Total thyroidectomy 110
Tracheal stenosis 113
Tracheobronchial tree 75
Tracheostomy 112
Transabdominal preperitoneal repair 118
Transurethral resection of prostate 35, 142
anesthesia 142
contraindications 142
indications 142
Transurethral resection set 46
Transverse suprapubic Pfannenstiel incision 141
Transversus abdominis muscle 140
Trendelenburg operation
anesthesia 106
complications 105
indication 105
position 106
relative contraindications 106
Triamterene stones 82
Triangle sign 72
Triway cannula 54
Triway Foley catheter 141
T-tube 55
T-tube cholangiogram 79
contraindications 80
indication 80
method 80
U
Upper airway obstruction 45, 112
Upper prostatic urethra 142
Ureteric stones
differential diagnosis 83
KUB region anteroposterior view 83
Ureterogram phase 86
Urethra 87
Urethral catheterization 42
Urethrograms 87
indications 87
types of
retrograde urethrography 87
ascending urethrography 87
Uric acid stones 82
Urinary bladder
calculi 84
stone, differential diagnosis 84
Urinary retention 100
Urobag 55
Urograffin 86, 92
V
Vas holding forceps 16
Vasectomy, techniques of 147
Venesection
anesthesia 107
indications 107
sites for 107
Ventral hernias 64
Vesical calculus 84
Vesicostomy 144
Vesicoureteral reflux 88
W
Wall of intestine 73
Wangensteen-Rice invertogram 91
AP and lateral view, X-ray
indication 91
Water repellent 66
Witzel type 123
Wound
complications 100
dehiscence 100
infections 100, 112
Woven non-allergic fabric 66
X
Xanthine stones 82
X-ray
abdomen with multiple air fluid levels 73
how to describe 69
with enormous amount of free gas 71
Z
Zinc oxide 120
×
Chapter Notes

Save Clear

SECTION 4
97OPERATIVE STEPS
CHAPTERS
98

INTRODUCTIONCHAPTER 20

There are several things to remember before describing any operative step.
 
PREOPERATIVE PREPARATION
  • ❖ Clinical evaluation: History + Physical Examination + Routine Blood Tests +/- Chest X-ray, ECG, 2D Echo
  • ❖ Part preparation: Removal of hair by epilating cream is a better method than shaving as it may cause microscopic cuts which may cause infection.
    If shaving needs to be done, it should be done in morning hours prior to surgery
  • ❖ Preoperative antibiotics
  • ❖ Nil per oral (NPO): Patient should have been fasting for 6–8 hours prior to surgery especially for general anesthesia
  • ❖ Written and informed consent
  • ❖ Tetanus prophylaxis – After taking proper history of immunization
  • ❖ Pre anesthetic check up.
 
PREPARATION ON OT TABLE
  • ❖ Position of the patient
  • ❖ Type of anesthesia to be given
  • ❖ Painting of operative field
    • Usually done with one coat of savlon, one coat of spirit and 2–3 coats of betadine at last
  • ❖ Draping of operative field (Exposure of operative field only).
 
SUTURES USED IN CLOSING OF DIFFERENT LAYERS OF INCISION
This is a basic concept and can be used at the end of each operative note if a detailed description of closure of incision layers is required.
Layer of incision
Suture used
Preferably
Skin
Nylon
Interrupted mattress
Subcutaneous tissue
Chromic/Vicryl
Interrupted simple
EOA/Rectus sheath/Fascia
Vicryl / PDS
Continuous
Muscle
Vicryl/Chromic
Interrupted
Peritoneum
Vicryl
Continuous
  • ❖ Size of these sutures may vary with the type and size of wound.
  • ❖ Different surgeons may use different types of sutures for different layers depending on their personal preference.100

Complications

  • These are some of the complications which can be mentioned in any major surgery.
    Groups
    Complications
    Chest Complications
    • Bronchopneumonia
    • Postoperative lung atelectasis
    • Deep vein thrombosis with pulmonary embolism
    • Aspiration
    General
    • Fever
    • Septicemia
    • Urinary retention (spinal anesthesia)
    • Pain
    • I.V cannula thrombophlebitis
    • Injection related abscess
    Wound Complications
    • Wound dehiscence
    • Wound infection
    • Cellulitis
    • Incisional hernia formation
    • Stitch abscess
    Intraoperative complications
    • Bleeding from vessels
    • Injury to surrounding structures like vessels, bowel, etc.
    • Electrocautery related thermal injuries
    • Slipping of sutures (After ligating pedicles of major organs)
    Specific surgery-related complications
    • Described individually in each operative step