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PRINCIPLES OF GENERAL SURGERY

Dr. Noel Binayas


June 19, 2013
Group 9 v2.0
OBJECTIVES:
To gain an appreciation of the broad
perspectives of the Specialty and Filed of
Surgery (The Cutting Specialty)
o Historical Perspectives
o Surgical Training at Present
o The Surgical Curriculum

The
Philippine
College
of
Surgeons

The
Philippine
Society
of
General Surgery
o Patient Safety in Surgery
HISTORICAL PERSPECTIVES

Chirurgery

Latin: chirurgia

Greek: cheir=hand; ergon=work

Anglicized to Surgery

Ambroise Pare, a 16th century French surgeon


stated that there were five reasons to perform
surgery:
o To eliminate that which is superfluous
o To restore that which has been
dislocated
o To separate that which has been united
o To join that which has been divided
o To repair the defects of nature

The three principal obstacles which had


plagued the medical surgical profession from
its infancy, namely:
o Bleeding
o Pain
o Infection
*Dr. Ladd- father of surgery
EARLIEST TIMES

Trephanation
o Boring holes in the head to release
evil spirits; relieve intracranial
pressure and drain intracranial
fluid
o Neolithic

6500 BC- France


o New World

1500 BC- Inca

Dentistry
o 7000 BC- Mehgarh, Pakistan
o 2650 BC- Egypt
ANCIENT EGYPT

2000-2500 BC

For Religious reasons

Trephination

Draining dental abscesses

Circumcision

Castration

Amputation

Lithotomy

Opiates
ANCIENT INDIA

600 BC- Sushruta Samhita


o 120 surgical instruments

300 surgical procedures

Incision and Drainage

Rhinoplasty

Bowel anastomosis

Cataract removal

Prostatectomy

Tonsillectomy
o Leeches- for sucking out edema and
blood
o Ethical Code
o Technical skills lab
*Flies- for dead debris
ANCIENT GREECE

Kritodermos and Alexander the Great


o Operated with a spoon
o Alexander the Great was saved by
Kritodermos during his last battle
in the Hindu river that is why he
promoted surgery

460-370 BC- Hippocrates


o Disliked opening the body
o Knowledge from the battlefield

3rd century BC
o Herophilus: allowed to dissect
o Arcagathus: famous for enthusiastic
use of knife and cautery

130 AD-200 AD
o Claudius Galen- Gladiators surgeon,
advanced practice
MIDDLE AGES

5th-14th century AD
o Practice of surgery declines
o Left to barbers
o Dark Ages- all negative info
dessiminated;
no
renowned
scientific breakthrough/invention

By the end of the middle ages, most of


the surgical breakthroughs came from
England.
MODERN SURGERY

There is no more science in surgery than in


butchering.- Lord Thurlow

Bleeding
o 10th century: Ligatures- Abulcasis
o 16th century: ligatures over cauteryAmbroise Pare
o 20th/21st century: ABO system (1901Karl Landsteiner); Diathermy; Harmonic
Scalpel
(Increases
operation
efficiency by 70% because it
reduces operation time; ligate big
arteries instead of using cautery)

Infection
o 1847: Handwashing- Ignaz Semmelweis
o 1860: Germ theory- Louis Pasteur
o 1867: Cleanliness and gloves- Joseph
Lister

Awareness of Nosocomial
Infection
o 1928: Penicillin- Alexander Flemming

Anaesthesia
o 200: Hua tuo
o 1842: Ether- Crawford Long
o 1844: Nitrous Oxide- Horace Wells
o 1846: Ether- William Morton
o

1847: Ether- John Snow (Father of


Public Health)
o 1596-1942: Curare- Walter Raleigh and
Harold Griffith
o First anesthesia is drinking alcohol
(drowning patients with alcoholic
beverages)

Other big names:


o 1316- Guy de Chauliac

Chirurgia magna
o 1616- William Harvey

An Anatomical Exercise on the


Motion of the Heart and Blood
in Animals
o 1651- Richard Wiseman

Several Chirurgical Treatises


o 1661- Marcelo Malpighi

Describes capillaries
o 18th century- John Hunter
Hunters Canal/ adductor
canal

Anatomist and Surgeon


o 1895- Wilhelm Conrad Rontgen

X-rays
o 1953- John Gibbon

Heart/Lung bypass machine

Modern Laparoscopy
o 1901- Cystoscope, Kelling

Used
in
TURP
(Transurethral Resection of
the Prostate
o 1911- Proctoscope, Bernheim
o 1918- Pneumoperitoneum, Goetze

Introduction of CO2 to
peritoneum to visualize
abdominal organs
o 1929- 135o scope, Kalk
Before, only 90o scope
(limited vision)
o 1934- Forceps and Cautery, Ruddock
o 1936- Sterilization, Boesch
o 1938- Veress Needle
o 1977- Assisted appendicectomy, Dekok
o 1983- Appendicectomy, Semm
o 1985- Cholecystectomy, Muhe
o 1996- Robotic telesurgery
SURGICAL TRAINING

Philippine College of Surgeons

American College of Surgeons

Royal College of Surgeons

The Company of Surgeons (Surgeons and


Barbers)

International Surgical Societies, Collaborative


Study Groups, etc.
SURGICAL TRAINING PHILIPPINE SOCIETY OF GENERAL
SURGEONS (PSGS)

Mission:
o We are a fellowship of highly
competent, safe, compassionate, and
ethical surgeons dedicated to pursue
excellence in the art and science of
general surgery as a distinct specialty,
promote the welfare of its members,
uphold the highest standards of
o

practice, and provide quality care to all


surgical patients.

Vision:
o The Philippine Society of General
Surgeons is the premier organization of
general surgeons, highly esteemed and
recognized
for
their
pioneering
achievements in continuing surgical
education, training and research,
dedicated to promote the welfare of its
members, to provide compassionate
and quality health care, and responsive
to the needs of the community.

Goals of Surgical Training


o Clinician/ Medical practitioner
o Medical educator
o Leader and manager
o Academic and clinical researcher

The general objective of the training


program:
o At the end of the Residency Training,
the Graduate should have acquired
clinical competence in the diagnosis
and management of surgical disorders.

The Competencies These are the abilities that


residents in all levels of training in surgery
have to acquire and develop.
o Cognitive Domain:

Knowledge

Comprehension

Intellectual skills

Data-gathering

Analysis

Problem-solving

Decision-making

Critical thinking
o Psychomotor Domain:

Technical skills

Communication skills
o Affective Domain:

Interpersonal skills

Professionalism
*There is more to Surgery than Science
Surgeons are not (should not be) mere technicians
SENSEI!
PATIENT SAFETY

Patient Safety in Surgery

World Alliance for Patient Safety

WHO Guidelines for Safe Surgery


10 ESSENTIAL OBJECTIVES FOR SAFE SURGERY:
1. The team will operate on the correct patient at
the correct site.
Before, the surgeon is considered
the Captain of the Ship; his word
is the law
Surgical site must be marked with
an arrow and initials of the
surgeon
Remember: Above all, do no harm.
2. The team will use methods known to prevent
harm from administration of anaesthetics,
while protecting the patient from pain.
3. The team will recognize and effectively prepare
for life threatening loss of airway or respiratory
function.

4.
5.
6.
7.
8.

The team will recognize and effectively prepare


for risk of high blood loss.
The team will avoid inducing an allergic or
adverse drug reaction for which the patient is
known to be at significant risk.
The team will consistently use methods known
to minimize the risk for surgical site infection.
The team will prevent inadvertent retention of
instrument or sponges in surgical wounds.
The team will secure and accurately identify al
surgical specimens.

9.

The team will effectively communicate and


exchange critical information for the safe
conduct of the operation.
10. Hospitals and public health systems will
establish routine surveillance of surgical
capacity, volume and result.
*Patient should sign in before induction of anaesthesia,
before skin incision, and before patient leaves the
operating room.
Source: Dr. Binayas Powerpoint Presentation