Basic Surgical Skills

Indonesia 2016
 Aims
• To learn one safe way to do a surgical
procedure. It is not the only method of
performing a surgical procedure, but we
endeavour to teach one safe way
• The course should be not only instructive and
educational but also enjoyable
• Acquire good habits earlier – it is difficult to
unlearn bad habits
 Theatre Etiquette

Gowning and Gloving

• Dress

• Scrubbing
 Safety
• NEVER DIRECTLY HANDLE SHARPS WITH YOUR
FINGERS (i.e. blades or needles)

• Pass sharps in a kidney dish to your assistant / nurse

• Safety of all is responsibility of operating surgeon
• Always dispose of sharps in a sharps bin
− not on patient or operating table!
• In case of injury
• assess the injury
• assess patient status
 Handling Instruments
Basic Principles:

• Safety
• Economy of movement
• Relaxed handling
• Avoidance of awkward movement
 Handling Instruments (cont.)‫‏‬
Cutting Instruments:
• Scalpel
- attachment
- detachment
- holding - like a table knife
- like a pen
- cutting
- passing the scalpel in a kidney dish

• Scissors (2 types) - holding

- cutting
 Handling Instruments (cont.)‫‏‬
Holding Instruments:

• Forceps (toothed and non-toothed) - holding

• Artery Forceps

• Needle Holders
 Knots
• Knot-tying is a fundamental technique in
surgery, and is often performed badly

• Take time to perfect your knotting technique

• Uses of knots:
− Tying sutures
− Ligation (tying vessels)‫‏‬
 General Principles of Knot-Tying
• Firm and unable to slip
• Small, to minimise foreign material and
foreign body reaction
• Don’t‫‘‏‬saw’‫‏‬the‫‏‬material‫ –‏‬it will weaken the
thread
• Don’t‫‏‬damage‫‏‬it‫‏‬by‫‏‬grasping‫‏‬with‫‏‬instruments‫‏‬
except at the free end
 General Principles of Knot-Tying
• Avoid excessive tension
• Avoid tearing tissue
• Apply tension horizontally

The standard knot used in surgery is the

reef or square knot, with a third throw for security.
- Alternate‫‏‬tying‫‘‏‬index‫‏‬finger’‫‏‬knots‫‏‬and‫‘‏‬middle‫‏‬
finger’‫‏‬knots‫‏‬at‫‏‬the‫‏‬same‫‏‬time‫‏‬as‫‏‬the‫‏‬hands‫‏‬
cross over for each throw
 Types of Knots
• Reef / Square Knot - one hand
- two hands
- instrument tie
• Surgeon’s‫‏‬Knot - one hand
- two hands
- instrument tie
• Slip Knot - must always be followed by a
reef knot
 Handling Sutures
• Tension – attempt to remove all elements of
tension from any anastomosis
• Insert needle at right angles to the tissue and
gently advance through the tissue, avoiding
shearing forces
• As a rough rule of thumb, the distance from the
edge of the wound should correspond to the
thickness of the tissue
• Successive sutures should be placed at twice
this distance apart, i.e. double the depth of
tissue sutured.
•
 x (tissue thickness)‫‏‬

x 2x

•-same distance apart

and same distance
from edge
Long wound : half – half

Ellipse : start from either end

 Handling Sutures (cont.)‫‏‬
• All sutures should be placed at right angles to
the line of the wound at the same distance from
wound edge and same distance apart in order
for tension to be equal down the wound length

wound
edge parallel, same distance
apart, same distance
from edge
 Handling Sutures (cont.)‫‏‬

• NO suture should be tied under too much

tension
• Go through one edge at a time in most cases
• Ellipse - length is 3x width
- suture either end
• Long wound : half and half
• Cut 0.5 cm from knot
• Removal : flush to skin